Reviews of the Depuy Synthes MatrixRIB Fixation System | Which Medical Device

We have been using Matrix for flail chests and multiple rib fractures since 2010 and have done over 30 cases. These cases tend to get referred urgently and are done in the next two or three days on the orthopaedic trauma lists to try and keep patients from a ventilator or minimise their time on a ventilator.  A small number of randomised trials, with limited number of patients, do show benefit in the short and long term.     

 

The plates are manufactured by Synthes and there are three types. 

 

1) Right sided plates which are a rose pink colour and these plates are shaped to match the contour of the ribs and are paired in that that they would do either e.g. 7th rib  or 8th ribThese plates are usually quite long and although they would do a large flail segment we often find that we can cut these to shape/size and get two plates out of one single plate. 

 

2) Left sided plates which are blue in colour and are numbered similarly to those on the right. 

 

3) Universal plates which are gold in colour and can be used on either side.  In practice we use these quite frequently. 

 

The principle is to identify the fracture from pre-operative rendered CT views plus  correlation with the transverse sections of the CT scan on the bony or mediastinal settings. Site of  incision is then planned  and this needs to be thought about carefully and correlated with the CT scan, the rendered views therein,  and also clinical examination. The latter is best done under anaesthesia as there can be a lot of discomfort for the patient. In practice we usually make a small incision over where we think the most likely fracture is and then once inside the chest, through the muscle layers, we can palpate other fractures and enlarge the incision accordingly.   

 

Once through the muscle layers of the chest wall such as the latissimus, occasionally  the serrate anterior, soft tissues are cleared from the rib with a Dewar’s  elevator and the fracture identified.  A plate is chosen and can be adjusted and bent to suit. Frequently, particularly if there is a stove-in component to the chest, we make a small incision (1-2cm) in the intercostal muscle and elevate the fracture with an instrument or finger. 

 

Using drill guides, the holes are drilled usually starting posteriorly to the fracture and once the fracture is stabilised by having the locking screw through the plate  behind the fracture, then a second one in front of the fracture, other screws are added to produce three on each side of the fracture ideally.  It is important to make sure that before drilling is undertaken that the plate lies square on the rib (i.e. neither too cranial nor too caudal) and the drill goes through both cortices.   This is quite easy to feel and see (and hear as the drill slows) in practice.