Surgical stabilization of rib fractures after penetrating thoracic injury: A chest wall injury society multicenter study

Abstract

Introduction: Surgical stabilization of rib fractures (SSRF) has emerged as an acceptable modality to manage chest wall injuries in select patients after blunt thoracic injury; however, its use in penetrating trauma has not been described. Materials and Methods: An international, retrospective study was carried out in two centers who reported experience with SSRF following penetrating chest wall trauma. All adult patients (≥18 years) who underwent SSRF after penetrating thoracic trauma between January 1, 2008, and December 13, 2017 were included. Results: Thirteen patients were enrolled in the study. The entire cohort was male with a median age of 28 years (interquartile range [IQR] 22, 33). Chest wall injury was due to firearm and impalement injuries in 10 (77%) and 3 (23%) patients, respectively. Indications for SSRF included chest wall instability (n = 8), mechanical ventilation or impending respiratory failure (n = 7), and pain (n = 4). Median time to SSRF was 24 h (IQR 20, 48). A median of 3 rib fracture lines (IQR 2, 4) were identified on imaging, and a median of 3 plates (IQR 2, 4) were placed in each patient. Six patients (46%) were extubated immediately after SSRF and the remainder required 3 (IQR 2, 6) days of mechanical ventilation. No patient required a tracheostomy. There were no cases of hardware failure, empyema, hemothorax, or death during hospitalization. Conclusion: In this series, 13 patients with penetrating thoracic injuries underwent SSRF with improved clinical outcomes. These data demonstrate that SSRF can be safely and effectively utilized in patients with penetrating chest wall injuries.