In a first for Sunshine Coast Health, one of our surgeons has completed a rib fixation operation on a trauma patient.
Specialist Cardiothoracic Surgeon Dr Jeffrey Macemon was recently asked to be involved in the treatment of a man who had experienced extreme trauma to the entire right side of his body following a motorcycle crash.
57-year-old Yianni Garofalakis broke 13 ribs, his shoulder (scapula), collar bone (clavicle) and right thighbone (femur).
“One of the things we look at for rib fixation is whether someone is able to be extubated and breathe on their own – he was able to be extubated, but he was still requiring significant respiratory support with high-flow and high-pressure oxygen,” Dr Macemon said.
“His chest, as the days were going on, was gradually becoming more unstable, he was experiencing a lot of pain and he couldn’t stand with a physical therapist, so that’s when I got asked to get involved and would he be a candidate for a rib fixation.”
Dr Macemon said Yianni was the ideal candidate, and the surgery was scheduled for late August.
“Two of his ribs in particular were poking into his chest and almost touching his heart on the inside as well, so that’s not going to fix itself long term so surgical repair became necessary,” he said.
During the operation, Dr Macemon used rigid fixation plates and screws to fix four of Yianni’s ribs. He also had a video-assisted thoracoscopy surgery, which treated a buildup of air or extra fluid around the lungs, as well as a fixation of the clavicle by the orthopaedic team.
“When you break a limb bone for instance you put a cast on it or they fix it with plate and screws, it’s fine it can be immobilised, but the chest is a different beast – you are constantly breathing so it constantly has to move so you can’t rigidly fix it completely you have to leave that ability to breathe,” Dr Macemon said.
Dr Macemon is one of only few surgeons in Queensland who are trained to do rib fixations.
“Some patients don’t necessarily need it and will do better without it because to do the procedure it’s actually quite disruptive to the chest wall to get in, to expose the ribs to be able to fix them,” he said.
“There’s a couple more systems now that are minimally invasive and it can be done almost keyhole, which is one of the ones I’ve done on this gentleman.
“Because he had broken so many ribs down the side and the back and his chest was so unstable, he would have not done well without it - he would still be in significant pain and his breathing would be unlikely to get back to a relative normal state.”
Yianni said he was extremely grateful for Dr Macemon, as prior to the surgery he was in a lot of pain in ICU.
“When he first came in, I remember saying to him, ‘Are you a good doctor?’ while looking at him with a pleading look on my face,” Yianni said.
“He replied, and said I’m a really good doctor, and I responded please fix me man.”
Determined as ever, during recovery Yianni said he became known as ‘Mr Independent’ on the ward because as soon as he had a little movement, he would work to do things on his own.
“During physio I would always do much more than I needed to and when they asked me why I did that, I would give them the same answer every time,” he said.
“The more I do, the quicker I go home.”
Home…to his partner Penny who along with his three children Jonny, Nick and Sam, and grandchild Gemma kept him going.
“I wouldn’t have got through this whole ordeal without them,” Yianni said.
After around a month in hospital, Yianni has just been discharged and is continuing to work on his movements in the hopes he soon won’t need to use a crutch.
Sunshine Coast Health opened its thoracic unit in earlier this year, to provide advanced care to local patients, closer to home.