Leaning Into The Future: Normalizing The Application Of Surgical Stabilization Of Rib Fractures.

Abstract

Background: Rib fractures are a common traumatic injury, occuring in 10% of patients with blunt chest wall trauma. Currently, medical management is the standard of care for rib fractures, including pain control, oxygen supplementation, ventilation if required, and pulmonary rehabilitation. Despite advancements in critical care and technology, medically managed patients continue to experience several acute and chronic complications. However, within the last 20 years, muscle sparing and minimally invasive techniques such as surgical stabilization of rib fractures (SSRF) have emerged, leading to improved outcomes in patients with rib fractures. Typically, SSRF is performed on the third through eighth ribs due to their contribution to chest wall stability, while the first, second, eleventh and twelfth ribs are not plated. Case Presentation: Here, we present the case of a 63 year old female presenting as a tier 2 trauma who sustained multiple rib fractures after falling from a horse. The patient was initially managed in the ICU medically with pulmonary care and pain control, but experienced refractory pain and difficulty mobilizing under this treatment regimen. The patient was offered SSRF to reduce the displaced lateral and anterior fractures and elected to pursue surgical treatment in order to shorten her recovery time. Of note, the patient was noted to have an anatomical variant in which the axillary artery was visualized above the 2nd rib. Discussion: Patient specific risk fractures including overall bone health and comorbidities should influence treatment decisions when deciding between medical or surgical treatment approaches. However, in the past two decades, surgical stabilization of rib fractures, particularly in patients with flail injury and minimal comorbidities, has gained traction as a viable therapeutic alternative. Surgical stabilization of the second rib is considered more technically challenging due to the additional exposure required in the area and the surrounding vascular anatomy. Given the dramatic fracture pattern noted in this patient, the second rib was deemed the best target for initial plate placement, and resulted in a significant decrease in chest wall deformity and pain experienced by the patient in the post-operative period.