Me and my operation: Broken ribs? Now you donâ€™t just have to grin and bear it

By
Carol Davis

PUBLISHED:

19:45 EST, 22 April 2013

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UPDATED:

20:43 EST, 22 April 2013

Thousands of Britons break their ribs every year. Healing is painful and can take months, but new titanium plates can speed up the process. Cleone Pengelley, 60, a retired bed and breakfast owner, from West Sussex, underwent the op, as she tells CAROL DAVIS.

THE PATIENT

As I rode my new horse Athos in June 2011, the saddle suddenly slipped forward and he turned into a bucking bronco. I was thrown to the ground and landed flat on my back. Excruciating pain spread down my back from the left shoulder.

Paramedics whisked me to the Princess Royal Hospital in Haywards Heath, where X-rays revealed I had seven broken ribs, including two that had each snapped in two places. I was given painkillers and transferred to the Royal Sussex County Hospital in Brighton, where there are experts in pain management.

Cleone broke her ribs in a riding accident and now has a new system of titanium plates to stabilise them

There, a doctor assured me the ribs would heal by themselves over about three months. I was shocked it would take so long.

I went home four nights later, gulping the painkillers, which at first were codeine and later tramadol. But the drugs made me woozy and constipated, and I was still in too much pain to read or sleep properly. The injury meant I couldnâ€™t drive or do the gardening, and the painkillers took away my appetite.

Three weeks later, my situation worsened. I slipped off a reclining chair that had tipped forwards and, even though it was just a 9in drop to the floor, I was in agony. The fall had aggravated my rib injury just as the bones were starting to heal.

Doctors again assured me I was fine and the ribs would mend naturally, but the pain meant I was still struggling with everyday tasks.

Then a friend suggested I see a different specialist using my private health insurance.

I was referred to Tom Routledge, at the London Bridge Hospital, who explained that my shattered bones were so badly broken they could take ages to heal â€” and even then they might heal badly, leaving me in pain for years.

Mr Routledge told me about the new Synthes Matrix Rib System, which uses curved titanium plates fixed to the ribs with special screws to support them to speed up the healing process.

Iâ€™d never heard of it, but was desperate for a solution. I couldnâ€™t bear this half-life on painkillers, and had lost 2st throughÂ barely eating.

I was very nervous about having surgery, but we agreed I should have it as soon as possible so the ribs would have the best chance of healing well. So, at the end of July, I had the 90-minute operation under general anaesthetic.

I was on morphine for 24 hours afterwards, but the pain had changed â€” it was no longer coming from my ribs, but from the back muscles where Mr Routledge had made the incision. Within days I was moving around and doing gentle physiotherapy. Five days later I came home.

I was able to enjoy my daughter Venetiaâ€™s wonderful wedding in August. I was too weak to dance or do the flowers, so everyone had to wait on me! But I weaned myself off painkillers a few weeks later and realised how lucky Iâ€™d been. A friend of mine was in agony from broken ribs for almost a year before she heard of the titanium plates.

Without surgery, I could still have been in pain now, and the drugs would have turned me into a zombie.

The metal plates will stay in my body for life, but I canâ€™t feel them and they donâ€™t set off airport alarms. Iâ€™m now riding regularly, gardening, doing charity work and enjoying playing with my three grandchildren.

Barring the odd twinge, I have no pain. Iâ€™d like to see the operation offered to many more people.

THE SURGEON

Tom Routledge is a consultant thoracic surgeon at the London Bridge Hospital and Guyâ€™s andÂ St Thomasâ€™ Hospital.

Many thousands of Britons break ribs every year, often through horse riding, biking and contact sports. Frail elderly people are also at risk because their ribs are fragile and can break if they fall or even cough violently, and they take longer to heal.

The pain of broken ribs can be excruciating, so patients naturally try not to move around much. And because taking deep breaths and coughing is painful, thereâ€™sÂ an increased risk of pneumonia because phlegm builds up within the lungs and can oftenÂ get infected.

When bones break, the standard procedure is to immobilise them so they can heal properly. With a broken arm, weâ€™d use a splint or plaster cast, but you canâ€™t do that with ribs because they move constantly as we breathe, turn over in bed or even get out of a chair.

Healing typically takes two to four months, and sometimes they fail to heal properly at all. Often patients feel the ends of the ribs clicking and grinding against each other, which is distressing.

Even when ribs do heal, they can do so in the wrong position so any small movement puts pressure on the join, resulting in years of pain and disability.

For years there has been very little doctors could do for patients with rib fractures.

Previous attempts to splint broken ribs internally have been improvised from plates and screws intended for other bones, such as forearms. But these have been unsuccessful because ribs are like dry twigs and can splinter easily if you try to drive normal screws into them. Recently, several tailor-made systems have been developed that act like an internal splint to fix the ribs firmly in place so they can heal correctly and more quickly.

The Synthes Matrix Rib System, developed in Switzerland five years ago, uses a series of curved titanium plates around 10-20cm long and 10mm wide. They are sculpted in a factory and fine-tuned by a surgeon to fit the contours of the patientâ€™s ribs.

These plates have eight to ten holes in them, rather like Meccano, so we can drive in special screws. These are designed to fix the plates securely to the fragile rib so they form a strong internal splint and donâ€™t damage the bones.

This is very exciting because, for the first time, we have a real option to offer patients.

With this relatively quick and safe operation, the ribs are immediately stabilised, resulting in pain relief straight away.

Evidence shows the operation is of great benefit to patients with multiple or severe rib fractures. People over 65 could benefit in particular as they are more at risk of pneumonia.

This operation is now recommended by the National Institute for Health and Care Excellence, so is available increasingly on the NHS, as well as privately. But many doctors still donâ€™t know about it.

It takes 60-90 minutes under general anaesthetic.

First, I make a 10-12cm incision in the skin and muscles above the fracture and expose the broken ribs. Using specially designed clamps to grasp them, I pull them gently into the correct position. Then I place one of the curving metal plates against each broken rib.

We also inject a local anaesthetic into the adjacent nerves so healing is more comfortable. I then close the muscles and skin.

As this is major surgery, patients stay in hospital for three to five days, but the pain should be easing already. The ribs should heal within six to eight weeks, saving people a long and painful recovery and often continuing pain where the bones have healed in the wrong position.

The operation is pretty safe, although if the patientâ€™s other injuries are severe, the outcome cannot be guaranteed.

The risks are the generic dangers of any operation and depend more on the health of the patient than the surgery itself. Thereâ€™s also a small risk of bleeding, infection, and mechanical failure.

When I met Mrs Pengelley she was pale and drawn, and had difficulty moving and breathing. By her daughterâ€™s wedding she was a different woman.

The operation costs Â£10,000-Â£12,000 privately and around Â£6,000 to the NHS.