Rib Fracture Stabilization Reduces Chest Wall Pain following Blunt Thoracic Trauma

Abstract

Blunt Thoracic Trauma (BTT) encompasses a wide spectrum of varying pathologic conditions of the skeletal chest wall, pulmonary parenchyma and mediastinum [1-5]. Rib fractures are one of the most common injuries sustained following BTT and result in significant disability, largely due to pain [1]. Among chest trauma patients, up to 10% of all admissions have evidence of rib fracture, with mortality rates that can exceed 20% in some series [1-4]. Older patients and those with associated pulmonary injury experience the highest rates of death [1,3-5]. A consensus management strategy of patients sustaining skeletal chest wall injury remains undefined, largely due to the lack of randomized comparative data [3-5]. Rib fractures are often one component of a larger spectrum of thoracic trauma where the focus of care is toward organ function. To date, most of the available literature focuses upon those patients with severe chest wall injury where the treatment strategy is sustaining organ function and is directed by trauma society guidelines [4]. Patients with lesser degrees of injury to the thorax are treated with optimization of chest wall mechanics through chest physiotherapy and effective analgesia. Contemporary recommendations for pain management validate intravenous and epidural analgesia as the optimal modalities for control of thoracic pain [3,4]. The use of open reduction and internal fixation of broken ribs is debatable as these techniques are morbid and traditionally reserved to severely injured patients where the goal is to improve respiratory dynamics [4,5]. However, among BTT patients with isolated rib fracture and lesser concomitant injury, the treatment goal is alleviation of pain as noted previously [3]. A cohort of such patients, particularly those with displaced rib fractures, will continue to suffer severe pain, despite maximal medical therapy. In such patients, there may be a benefit to the application of rib fracture plating as a complimentary strategy for better pain control and decreased narcotic requirement [68]. The objective of this paper is to determine if rib fracture plating can be beneficial in the pain management algorithm of patients sustaining BTT who have predominantly displaced rib fracture injury.