50 - Chest Wall Trauma: Rib and Sternum Fractures

Abstract

Chest wall trauma associated with fractures of the ribs and/or sternum can contribute to a significant degree of morbidity and mortality in traumatized patients. With the gaining awareness of chest wall injury, more effort has been directed towards the evaluation of chest wall trauma, risk stratification of chest wall injuries, and the role of surgical intervention. Over the last decade, scientific investigation into operative fixation of rib and sternum fractures has grown, resulting in a greater clarity of surgical indications. Randomized controlled trials have unanimously demonstrated the benefit of surgery in flail chest patients requiring ventilation. Comparative cohort studies and case series have further suggested benefit exists in selected groups of severe, non-flail chest wall fractures. This chapter reviews chest wall trauma, outlining the initial work-up, pathophysiology, and implications of rib and sternum fractures. The chapter further explores nonoperative management strategies and offers an evidence-based evaluation of surgical indications. Surgical treatment, including common approaches, reduction/fixation techniques, and available implants are discussed in detail. The chapter concludes with a critical appraisal of the published outcomes for both operative and nonoperative management of chest wall fractures.