Emergency Sternotomy for Innominate Injury During Percutaneous Tracheostomy: An Argument for Early Surgical Fixation

Abstract

Rib fractures account for 85% of blunt thoracic trauma and are associated with up to 33% morbidity and 25% mortality. Age, number of rib fractures, and flail segment are associated with poorer outcomes, longer duration of mechanical ventilation and hospital length of stay. Current management standards include locoregional analgesia, supportive ventilation, and physiotherapy. Surgical rib fixation has been shown to reduce morbidity, mortality, duration of mechanical ventilation, rates of tracheostomy, and length of stay in flail rib fractures. Whilst surgical fixation is becoming more popular, patient selection consensus and evidence in multiple and multi-segmental rib fractures is lacking. We present a case of conservatively managed rib fractures resulting in unplanned emergency sternotomy, and advocates for early surgical rib fixation to reduce risks of extended ventilation, tracheostomy, and their inherent complications.