Rib Plating Offers Favorable Outcomes in Patients With Chronic Nonunion of Prior Rib Fractures

Abstract

Although open reduction and internal fixation (ORIF) is an accepted treatment for a proportion of acute rib fractures, The literature on its potential to treat chronic, nonunion fractures is scarce. This study evaluates the outcomes and quality of life of patients who underwent ORIF for chronic, symptomatic, nonunion rib fractures. Thirty-two patients were explored for possible ORIF of nonunion rib fractures (≥6 months after injury). After excluding non-English-speaking patients (n= 1), those where no instability was noted at surgery (n= 3), and those deceased at the time of study (n= 4), 24 patients were eligible. Telephone interviews were conducted using a previously published rib fracture pain questionnaire. Seventy percent of eligible patients (19/24) consented and completed the questionnaire at a median of 55 months (interquartile range, 24-62) from surgery. Injuries were classified as multisystem trauma (n= 4) or isolated rib fractures (n= 15). The median pain severity (on a scale of 1 [none/mild] to 10 [severe]) significantly decreased from preoperatively (9; interquartile range, 7-10) to postoperatively (1; interquartile range, 0-2; P < .001). Most patients returned to daily activities, were able to work at their preinjury level, were satisfied with their surgery, and would undergo operative management again. Patients who underwent ORIF reported a significant decrease in fracture-associated symptoms and pain severity postoperatively. Most returned to daily activities, could work at preinjury levels, and were satisfied with surgery. ORIF should be considered as an option to help patients with symptomatic nonunion rib fractures.