Abstract
BackgroundMultiple rib fractures and unstable thoracic cage injuries are common in blunt trauma. Surgical management of rib fractures has received increasing attention in recent years and the aim of this 1-year, prospective study was to assess the long-term effects of surgery.MethodsFifty-four trauma patients with median Injury Severity Score 20 (9–66) and median New Injury Severity Score 34 (16–66) who presented with multiple rib fractures and flail chest, and underwent surgical stabilization with plate fixation were recruited. Patients responded to a standardized questionnaire concerning pain, local discomfort, breathlessness and use of analgesics and health-related quality of life (EQ-5D-3 L) questionnaire at 6 weeks, 3 months, 6 months and 1 year. Lung function, breathing movements, range of motion and physical function were measured at 3 months, 6 months and 1 year.ResultsSymptoms associated with pain, breathlessness and use of analgesics significantly decreased from 6 weeks to 1 year following surgery. After 1 year, 13 % of patients complained of pain at rest, 47 % had local discomfort and 9 % used analgesics. The EQ-5D-3 L index increased from 0.78 to 0.93 and perceived overall health state increased from 60 to 90 % (p < 0.0001) after 6 weeks to 1 year. Lung function improved significantly with predicted Forced vital capacity and Peak expiratory flow increasing from 86 to 106 % (p = 0.0002) and 81 to 110 % (p < 0.0001), respectively, from 3 months to 1 year after surgery. Breathing movements and range of motion tended to improve over time. Physical function improved significantly over time and the median Disability rating index was 0 after 1 year.ConclusionsPatients with multiple rib fractures and flail chest show a gradual improvement in symptoms associated with pain, quality of life, mobility, disability and lung function over 1 year post surgery. Therefore, the final outcome of surgery cannot be assessed before 1 year post-operatively.
Highlights
Multiple rib fractures and unstable thoracic cage injuries are common in blunt trauma
We have found plate fixation of rib fractures to be a safe method with a low rate of complications and a reduced time and need for ventilator treatment in comparison to Caragounis et al World Journal of Emergency Surgery (2016) 11:27 conservatively-managed, historical controls [9]
Nineteen patients were on ventilator preoperatively and 24 patients were on ventilator 24 h postoperatively
Summary
Multiple rib fractures and unstable thoracic cage injuries are common in blunt trauma. Surgical management of rib fractures has received increasing attention in recent years and the aim of this 1-year, prospective study was to assess the long-term effects of surgery. Multiple rib fractures occur in 10 % of poly-traumatized patients due to blunt, high-energy trauma [1] and can lead to unstable thoracic cage injuries or flail chest [2] with respiratory insufficiency. Our patients were reported to have experienced mild disability, decreased range of motion and lung function, and 35 % of patients had enduring pain after 6 months [10]. Two studies have reported significantly better lung function in surgically-managed patients 1 month after surgery [6, 7], whereas Marasco et al [8] found no significant difference between operated and conservatively-managed patients after 3 months. There is a disparity in the surgical techniques used in these studies, which makes comparison difficult
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