Fixation Of Rib Fractures Research Articles

Surgical Fixation of Flail Chest Injuries: Reduction and Fixation Options, Tips and Tricks

Summary: Modern techniques of rib fracture fixation surgery follow the AO principles of fracture reduction, fixation, and appropriate soft tissue handling. Fixation techniques can be performed using anatomic reduction and rigid fixation, or bridge plate fixation for comminuted fractures. Anatomic and nonanatomic plates can be used, although titanium precontoured locking plates are the most commonly used. Other contemporary intra- and extramedullary fixation strategies have also been developed. Intrathoracic fixation is a novel technique, however, limited literature on clinical outcomes currently exists. This article discusses techniques of reduction, fixation, and tips and tricks for surgical fixation of rib fractures.

Fixation of rib fractures is beneficial for patients with chronic obstructive pulmonary disease, a trauma quality improvement program study

BackgroundInternal fixation for multiple rib fractures is well established. Patients with underlying chronic obstructive pulmonary disease (COPD) have a higher rate of perioperative complications. It is unclear if these patients are suitable candidates for internal fixation and if surgical interventions are harmful to these patients.Study Design and methodsAdult patients with ≥ 3 rib fractures and underlying COPD from the Trauma Quality Improvement Program between 2017 and 2019 were eligible for inclusion. The patients were divided into two treatment groups: operative and non-operative. Furthermore, inverse probability treatment weighting was applied to analyze mortality and adverse hospital events.ResultsPatients with COPD in the operative group had higher ventilator use (odds ratio [OR], 3.211; 95% confidence interval [CI], 1.993–5.175; p < 0.001). Additionally, they had a longer length of stay (coefficient β, 4.139; standard error, 0.829; p < 0.001) and longer ventilator days (coefficient β, 1.937; standard error, 0.655; p = 0.003) than in the non-operative group. Furthermore, the mortality rate was lower in the operative group than in the non-operative group (OR, 0.426; 95% CI, 0.228–0.798; p = 0.008).ConclusionInternal fixation of rib fractures plays a crucial role in patients with underlying COPD disease. They presented a better mortality rate without an increased perioperative complication rate.

Comprehensive analysis of risk factors for postoperative wound infection following open reduction and internal fixation of Rib fractures

BackgroundPostoperative wound infections (PWIs) significantly impact patient outcomes following open reduction and internal fixation (ORIF) of rib fractures. Identifying and understanding risk factors associated with these infections are crucial for improving surgical outcomes and patient care.MethodsThis retrospective study, conducted from January 2020 to October 2023 at our institution, aimed to analyze the risk factors for PWIs in patients undergoing ORIF for rib fractures. A total of 150 patients were included, with 50 in the infected group and 100 in the non-infected control group, matched for demographic and clinical characteristics. Data on variables such as intraoperative blood loss, hospital stay duration, body mass index (BMI), operation time, presence of anemia, drainage time, diabetes mellitus status, smoking habits, and age were collected. Statistical analysis involved univariate and multivariate logistic regression using SPSS software (Version 27.0), with p-values < 0.05 considered statistically significant.ResultsUnivariate analysis revealed no significant association between intraoperative blood loss or hospital stay duration and PWIs. However, operation time ≥ 5 h, anemia, drainage time ≥ 7 days, diabetes mellitus, smoking, and age ≥ 60 years were significantly associated with higher PWI rates. Multivariate logistic regression confirmed these factors as independent predictors of PWIs, with operation time and diabetes mellitus showing particularly strong associations.ConclusionsProlonged operation time, anemia, extended drainage, diabetes mellitus, smoking, and advanced age significantly increase the risk of PWIs following ORIF for rib fractures. Early identification and targeted management of these risk factors are essential to reduce the incidence of infections and improve postoperative outcomes.

ThP7.13 - A systematic review of the perioperative outcomes of surgical fixation versus conservative approach for severe rib fractures

Abstract Objective The objective of this meta-analysis is to compare the patient outcomes for severe rib fractures being managed by operative or non-operative treatment. Methods Studies reporting patient outcomes in patients undergoing surgical fixation or conservative approach were selected from medical electronic databases and meta-analysis was conducted by following the guidelines of the Cochrane Collaboration using statistical software RevMan version 5. Results Three studies on 258 patients reporting patient outcomes were included. In the random effect model analysis, the total hospital stay [mean difference -1.44, 95%, CI (-2.88, 0.00), Z = 1.96, p = 0.05] was comparable between the two groups with no heterogeneity among included studies. The intensive care stay [mean difference -2.36, 95%, CI (-5.92, 1.21), Z = 1.30, p = 0.20] and mortality [odds ratio 1.08, 95%, CI (0.11, 10.31), Z = 0.07, p = 0.94] was comparable between the two groups but with moderate heterogeneity among included studies. Pneumonia was more common in patients of the non-operative group [odds ratio 0.35, 95%, CI (0.15, 0.82), Z = 2.41, p = 0.02] with no heterogeneity among included studies. Conclusion Pneumonia was more common in patients in the patients managed with the conservative approach. Other patient outcomes were comparable between the two groups. Due to the paucity of data, multiple other crucial variables could not be assessed and a major multi-centre randomised control trial is needed to confirm the findings of this meta-analysis.

Return to work and activity after rib-fixation for acute chest trauma: first application of a validated patient-reported outcomes assessment tool.

Rib fractures present a heavy pain and functional burden in trauma. Our primary aim was to determine return to work in patients with acute rib fractures requiring surgical stabilization of rib fractures. Our secondary outcomes were pain and quality of life. We also document the first application of the Work Productivity and Activity Impairment Instrument, a validated injury-specific patient-reported outcome measure, for chest wall injury in the literature. A retrospective review was conducted on patients with rib fractures requiring surgical fixation in a single centre between 2008 and 2020. After applying inclusion and exclusion criteria to ensure relevance, all eligible patients were asked to complete patient-reported outcome measure questionnaires. Of 1841 trauma patients with rib fractures, 66 underwent surgical fixation. Thirty-nine patients were eligible and 31 completed the questionnaires. Pre-injury and post-injury answers were compared. The number of patients in employment decreased postoperatively from 22 to 16 (P = 0.006). For those who returned to work, there was no difference in hours missed but reduced weekly hours and productivity scores. There were significantly more patients with pain and on pain relief. There was a lower quality of life score postoperatively. Approximately 1 in 5 patients who require surgical fixation for rib fractures will not return to work. This is the first chest wall trauma study that uses the Work Productivity and Activity Impairment Instrument, a validated tool for work productivity outcomes. We recommend this instrument as a reliable tool for investigating return-to-work outcomes in trauma patients.

The Effects of Pulmonary Risk Factors and Combination Thoracic Osseous Fractures on Mortality and Outcomes of Surgical Stabilization of Rib Fractures.

Rib fixation for traumatic rib fractures is advocated to decrease morbidity and mortality in select patient populations. We intended to investigate the effect of combination osseous thoracic injuries on mortality with the hypothesis that combination injuries will worsen overall mortality and that SSRF will improve outcomes in combination injuries and in high-risk patients. Patients with rib fractures were identified from the Trauma Quality Improvement Project registry from 2019. Patients were then divided into rib fracture(s) alone or in combination with sternal, thoracic vertebra, or scapula fracture. Patients were also categorized into those with COPD and smokers. Patients with AIS >3 outside of thorax were excluded. Patients were subcategorized into those who had rib fixation verse nonoperative management for all subgroups. Analysis was performed to evaluate the efficacy of rib fixation. A total of 111,066 patients were included for analysis. The overall mortality was 1.4%. Patients with COPD had over double the mortality risk, with an overall mortality of 3.4%. Combination injuries did not appear to increase mortality. SSRF did not decrease mortality; however, the number of patients in this group was too small to complete statistical analysis. The overall complication rate was 0.43%. There was a trend towards an increase in extrapulmonary complications in the group that underwent surgical fixation. Mortality from rib fractures with concomitant osseous thoracic fracture appears to be low. However, mortality is increased in patients with COPD regardless of rib fracture pattern. The number of patients who underwent SSRF was too small to make a statistical comparison.

Clinical effect of the internal fixation for rib fracture with single utility port complete video-assisted thoracoscopic surgery

BackgroundsThe internal fixation for rib fracture with single-operation-port (two ports) complete video-assisted thoracoscopic surgery (VATS) is a promising surgical approach for treating multiple rib fractures. The study aimed to investigate the minimally invasive surgical procedure’s clinical effect in treating multiple rib fractures.MethodsSeventy-three patients with multiple rib fractures were divided into two groups according to surgical procedure. In the study group, 42 patients were operated on with the internal fixation of rib fracture with single-operation-port complete VATS. In the control group, this study performed the open operative internal fixation for rib fracture with traditional thoracotomy on 31 patients. The surgical-related indexes were retrospectively analyzed. These included the operative time, the intraoperative blood loss, the drainage amount of the chest tube, the placement time of the chest tube, the postoperative hospital stay, the incidence of postoperative complications, the imaging efficacy of rib fixation of rib fractures, and visual analog scale of pain scoring (VAS scoring).ResultsThere was no difference in the operative time between the study and control groups (P = 0.806). The intraoperative blood loss, the chest tube drainage amount, the chest tube placement time, the postoperative hospital stay, and the incidence of postoperative complications in the study group were lower than those in the control group (P < 0.05). There was no significant difference in the imaging efficacy of rib fixation of rib fractures between the two groups (P = 0.806). VAS scores in the study group on the seventh postoperative day were significantly reduced compared with the control group (P = 0.026).ConclusionThe internal fixation for rib fractures with single-operation-port complete VATS is a feasible, safe, simple, and minimally invasive surgical procedure to treat multiple rib fractures, which is worthy of clinical application.

Surgical Rib Fracture Fixation: Early Operative Intervention Improves Outcomes.

This study aimed to assess the outcomes of patients with complex rib fractures undergoing operative or nonoperative management at our major trauma center. A retrospective review of all patients who were considered for surgical stabilization of rib fractures (SSRF) at a single major trauma center from May 2016 to September 2022 was performed. In total, 352 patients with complex rib fractures were identified. Thirty-seven patients (11%) fulfilled the criteria for surgical management and underwent SSRF. The SSRF group had a significantly higher proportion of patients with flail chest (32 [86%] vs. 94 [27%], p<0.001) or Injury Severity Score (ISS) >15 (37 [100%] vs. 129 [41%], p<0.001). No significant differences were seen between groups for 1-year mortality. Patients who underwent SSRF within 72 hours were 6 times less likely to develop pneumonia than those in whom SSRF was delayed for over 72 hours (2 [18%] vs. 15 [58%]; odds ratio, 0.163; 95% confidence interval, 0.029-0.909; p=0.036). Prompt SSRF showed non-significant associations with shorter intensive care unit length of stay (6 days vs. 10 days, p=0.140) and duration of mechanical ventilation (5 days vs. 8 days, p=0.177). SSRF was associated with a longer hospital length of stay compared to nonoperative patients with flail chest and/or ISS >15 (19 days vs. 13 days, p=0.012), whilst SSRF within 72 hours was not. Surgical fixation of complex rib fractures improves outcomes in selected patient groups. Delayed surgical fixation was associated with increased rates of pneumonia and a longer hospital length of stay.

A biomechanical study of a polymer material bundled rib fracture fixator.

Rib fractures are one of the most common blunt injuries, accounting for approximately 10% of all trauma patients and 60% of thoracic injuries. Multiple rib fractures, especially flail chest, can cause local chest wall softening due to the loss of rib support, leading to paradoxical breathing, severe pain, and a high likelihood of accompanying lung contusions. This study investigates the mechanical properties of a new polymer material rib internal fixator to provide theoretical data for its clinical use. We conducted in vitro mechanical tests on 20 fresh caudal fin sheep ribs, using different fracture models across four randomly assigned groups (five ribs per group). The fixators were assessed using non-destructive three-point bending, torsion, and unilateral compression tests, with results averaged. Additionally, finite element analysis compared stress and strain in the polymer fixators and titanium alloy rib plates during bending and torsion tests. In vitro tests showed that the polymer fixators handled loads effectively up to a maximum without increase beyond a certain displacement. Bending and torsion tests via finite element analysis showed the polymer material sustained lower maximum equivalent stresses (84.455MPa and 14.426MPa) compared to titanium alloy plates (219.88MPa and 46.47MPa). The polymer rib fixator demonstrated sufficient strength for rib fracture fixation and was superior in stress management compared to titanium alloy plates in both bending and torsion tests, supporting its potential clinical application.

Efficacy of Open Reduction and Internal Fixation Versus Conservative Treatment for Rib Fractures

Objective: To investigate the efficacy of open reduction and internal fixation versus conservative treatment for rib fractures. Methods: The study period was from June 2022 to June 2023, during which 70 patients with rib fractures were grouped by randomized numerical table method, with 30 cases in the observation group and 40 cases in the control group. The observation group implemented open reduction internal fixation treatment and the control group adopted conservative treatment. After treatment, the results of each index in the two groups were compared. Results: Treatment-related indexes, lung function indexes, and treatment effects between the two groups were compared (P &lt; 0.05). The Visual Analogue Scale (VAS) score and complication rate of the observation group after treatment were lower than those of the control group (P &lt; 0.05). Conclusion: In the comparison of the efficacy of open reduction internal fixation and conservative treatment for rib fractures, the former exerts a more significant effect and can improve the lung function of the patients, which is worthy of research and promotion.

Functionally graded 3D printed plates for rib fracture fixation

BackgroundDesign freedom offered by additive manufacturing allows for the implementation of functional gradients - where mechanical stiffness is decreased along the length of the implant. It is unclear if such changes will influence failure mechanisms in the context of rib fracture repair. We hypothesized that our novel functionally graded rib implants would be less stiff than controls and decrease occurrence of secondary fracture at implant ends. MethodsFive novel additively manufactured rib implants were tested along with a clinically used Control implant. Fracture reconstructions were modeled with custom synthetic rib bones with a transverse B1 fracture. Ribs were compressed in a cyclic two-point bend test for 360,000 cycles followed by a ramp to failure test. Differences in cyclic stiffness, 3D interfragmentary motions, ramp-to-failure stiffness, maximum load, and work to failure were determined. FindingsThe Control group had lower construct stiffness (0.76 ± 0.28 N/mm), compared to all novel implant designs (means: 1.35–1.61 N/mm, p < 0.05) and rotated significantly more about the bending axis (2.7° ± 1.3°) than the additively manufactured groups (means between 1.2° – 1.6°, p < 0.05). All constructs failed via bone fracture at the most posterior screw hole. Experimental implants were stiffer than Controls, and there were few significant differences between functional gradient groups. InterpretationAdditively manufactured, functionally graded designs have the potential to change the form and function of trauma implants. Here, the impact of functional gradients was limited because implants had small cross-sectional areas.

Intercostal cryonerve block versus elastomeric infusion pump for postoperative analgesia following surgical stabilization of traumatic rib fractures

ObjectivePatients with blunt thoracic trauma requiring surgical stabilization of rib fractures (SSRF) frequently experience severe pain. Further, a rising prevalence of opioid-tolerant patients sustain traumatic injuries. The optimal pain management adjunct for concurrent use with SSRF remains uncertain. This study compared outcomes in patients undergoing SSRF with concomitant cryonerve block (CryoNB) or ropivacaine 0.2% elastomeric infusion pump (EIP). MethodsA single-center retrospective comparative analysis was performed at a level II trauma center. A query of our institution's trauma registry of consecutive patients undergoing SSRF from October 2017 to November 2020 with either intercostal CryoNB or ropivacaine 0.2% EIP was conducted. Opioid consumption in oral morphine equivalents (OME), patient-reported pain scores by numerical rating scale, and pulmonary function measured by incentive spirometry effort (mL) were collected at baseline and on postoperative days 1–3. Results were analyzed using a linear-mixed-effects model. Length of stay (LOS), complications, and hospital charges were assessed as secondary outcomes. ResultsTwenty-six patients meeting inclusion criteria were evaluated. Patient demographics, injury, and surgical variables were similar between groups. The estimated effect for patients treated with CryoNB (n = 14) compared to EIP (n = 12) demonstrated a 25% (estimated -1.37 OME, 95% CI, -2.411 to -0.335, p = 0.01) reduction in hospital opioid requirements, fewer discharge opioids (41.3 mg (37.5–45) versus 175 mg (150- 200), p = 0.03), 22% (estimated -1.506, 95% CI, -2.722 to -0.290, p = 0.02) reduction in pain scores, and shorter postoperative LOS (4 days (4–5) versus 6 days (5–9.5), p = 0.04). Pulmonary function (estimated -48.8 mL, 95% CI, -312.74 to 215.05, p = 0.71), total hospital costs (CryoNB: $90,224 ± 34,633; EIP: $131,498 ± 73,072, p = 0.07), and complications were no different between cohorts. ConclusionThe addition of intercostal CryoNB as an adjunct to multimodal pain management in trauma patients undergoing surgical fixation of rib fractures may be of benefit. Based on our early data, this technique appears to be promising in reducing opioid requirements and providing an extended duration of pain control without increased costs or complications.

Better late than never-a single-center review of delayed rib fixation for symptomatic rib fractures and nonunions.

Surgical stabilization of rib fractures (SSRFs) has become an emerging therapy for treatment of patients with rib fractures. More commonly, it is used in the acute setting; however, delayed SSRF can be utilized for symptomatic rib fracture nonunions. Here, we describe our institution's experience with delayed SSRF, hypothesizing it is safe and resolves patient symptoms. This is a retrospective review of patients presenting to our Level I trauma center to undergo delayed SSRF for symptomatic nonunions from January 2017 to September 2022. Delayed SSRF was defined as SSRF over 2 weeks in the outpatient setting. Basic demographics were obtained. Outcomes of interest included mean pain score (preoperatively and postoperatively), intensive care unit (ICU) and hospital length of stay (LOS), and resolution of preoperative symptoms, specifically chest wall instability, with return to activities of daily living (ADLs). Forty-four patients met inclusion criteria with a total of 156 symptomatic nonunion rib fractures that received delayed SSRF. The average age was 59.2 ± 11.9 years and median number of days from injury to SSRF was 172.5 (interquartile range, 27.5-200). The average number rib fractures plated per patient 3.5 ± 1.8. Only three patients required ICU admission postoperatively for no longer than 2 days. Median hospital LOS was 2 days (interquartile range 1-3 days). Average preoperative and postoperative pain score was 6.8 ± 1.9 and 2.02 ± 1.5, respectively ( p < 0.001). Chest wall instability and preoperative symptoms resolved in 93.2% of patients postoperatively ( p < 0.001). Two patients (4.5%) had postoperative complications that resolved after additional surgical intervention. Rib fracture healing was demonstrated on radiographic imaging during postoperative follow-up. Delayed SSRF is safe and demonstrates significant resolution of preoperative symptoms by decreasing pain, improving chest wall stability, and allowing patients to return to activities of daily living. Therapeutic/Care Management; Level IV.

Application of preoperative 3D printing in the internal fixation of posterior rib fractures with embracing device: a cohort study

BackgroundTo explore the impact of preoperative 3D printing on the fixation of posterior rib fractures utilizing a memory alloy embracing device of rib under thoracoscopy.MethodsThe enrolled patients were divided into the 3D printing (11 patients) and the non-3D printing (18 patients) groups, based on whether a 3D model of ribs was prepared prior to surgery. Analysis was conducted comparing the average fixation time per fracture, postoperative fixation loss, and poor reduction of fractured end between the two groups.ResultsThe average fixation time of each fracture was 27.2 ± 7.7 min in the 3D printing group and 29.3 ± 8.2 min in the non-3D printing group, with no statistically significant difference observed between the two groups (P > 0.05). The incidence of poor fracture fixation in the 3D printing group was statistically lower than that in the non-3D printing group (12.9% vs. 44.7%, P < 0.05). Further stratified analysis revealed that the off-plate rate in the 3D printing group and the non-3D group was (3.2% vs. 12.8%, P > 0.05), and the dislocation rate of the fractured end was (9.7% vs. 31.9%, P < 0.05).ConclusionsThe application of 3D printing technology to prepare the rib model before surgery is proves beneficial in reducing the occurrence of poor fixation of fractures and achieving precise and individualized treatment.

If we should remove internal fixation devices for rib fractures?

BackgroundInternal fixation for rib fractures has been widely carried out worldwide, and its surgical efficacy has been recognized. However, there is still controversy about whether implant materials need to be removed. At present, the research on this topic is still lacking at home and abroad. Therefore, in this study, the patients undergoing removal of internal fixation for rib fractures in our department within one year were followed up, to statistically analyze implant-related complications, postoperative complications and postoperative remission rate.MethodsA retrospective analysis was conducted on 143 patients undergoing removal of internal fixation for rib fractures from 2020 to 2021 in our center. The implant-related complications, postoperative complications and postoperative remission rate of patients with internal fixation were analyzed.ResultsIn this study, a total of 143 patients underwent removal of internal fixation, among which 73 suffered from preoperative implant-related complications (foreign-body sensation, pain, wound numbness, sense of tightness, screw slippage, chest tightness, implant rejection), and 70 had no post operative discomfort but asked for removal of internal fixation. The average interval between rib fixation and removal was 17 ± 9.00 (months), and the average number of removed materials was 5.29 ± 2.42. Postoperative complications included wound infection (n = 1) and pulmonary embolism (n = 1). of the 73 patients with preoperative implant-related complications, the mean postoperative remission rate was 82%. Among the 70 patients without preoperative discomfort, the proportion of discomforts after removal was 10%. No perioperative death occurred.ConclusionFor patients with internal fixation for rib fractures, removal of internal fixation can be considered in the case of implant-related complications after surgery. The corresponding symptoms can be relieved after removal. The removal presents low complication rate, and high safety and reliability. For patients without obvious symptoms, it is safe to retain the internal fixation in the body. For the asymptomatic patients who ask for removal of internal fixation, the possible risk of complications should be fully informed before removal.

CO91 Surgical Fixation of Multiple Rib Fractures in Asian Population: A Systematic Literature Review and Meta-Analysis

CO91 Surgical Fixation of Multiple Rib Fractures in Asian Population: A Systematic Literature Review and Meta-Analysis

The effectiveness of early surgical stabilization for multiple rib fractures: a multicenter randomized controlled trial

IntroductionMultiple rib fractures (≥ 3 displaced rib fractures and/or flail chest) are severe chest trauma with high morbidity and mortality. Rib fixation has become the first choice for multiple rib fracture treatment. However, the timing of surgical rib fixation is unclear.Materials and methodsThe present study explored whether early rib fracture fixation can improve the outcome of multiple rib fractures. The present research included patients who were hospitalized in three Jiangsu hospitals following diagnosis with multiple rib fractures. Patients received early rib fracture fixation (≤ 48 h) or delayed rib fracture fixation (> 48 h) utilizing computer-based random sequencing (in a 1:1 ratio). The primary outcome measures included hospital length of stay, intensive care unit (ICU) stay, mechanical ventilation, inflammatory cytokine levels, infection marker levels, infection, and mortality.ResultsA total of 403 individuals were classified into two groups, namely, the early group (n = 201) and the delayed group (n = 202). Patients belonging to the two groups had similar baseline clinical data, and there were no statistically significant differences between them. Early rib fracture fixation greatly decreased the length of stay in the ICU (4.63 days vs. 6.72 days, p < 0.001), overall hospital stay (10.15 days vs. 12.43 days, p < 0.001), ventilation days (3.67 days vs. 4.55 days, p < 0.001), and hospitalization cost (6900 USD vs. 7600 USD, p = 0.008). Early rib fracture fixation can decrease inflammatory cytokine levels and infection marker levels, prevent hyperinflammation and improve infection in patients with multiple rib fractures. The timing of rib fracture fixation does not influence the surgical procedure time, operative blood loss, 30-day all-cause mortality, or surgical site infection.ConclusionThe findings from the present research indicated that early rib fracture fixation (≤ 48 h) is a safe, rational, effective and economical strategy and worth clinical promotion.

Rib Fixation for Multiple Rib Fractures: Healthcare Professionals Perceived Barriers and Facilitators to Clinical Implementation

BackgroundSurgical stabilization of rib fractures (SSRF) is associated with improved respiratory symptoms and shorter intensive care admission in patients with flail chest. For multiple rib fractures, the benefit of SSRF remains a topic of debate. This study investigated barriers and facilitators of healthcare professionals to SSRF as treatment for multiple traumatic rib fractures.MethodsDutch healthcare professionals were asked to complete an adapted version of the Measurement Instrument for Determinants of Innovations questionnaire to identify barriers and facilitators of SSRF. If ≥ 20% of participants responded negatively, the item was considered a barrier, and if ≥ 80% responded positively, the item was considered a facilitator.ResultsSixty-one healthcare professionals participated; 32 surgeons, 19 non-surgical physicians, and 10 residents. The median experience was 10 years (P25–P75 4–12). Sixteen barriers and two facilitators for SSRF in multiple rib fractures were identified. Barriers included lack of knowledge, experience, evidence on (cost-)effectiveness, and the implication of more operations and higher medical costs. Facilitators were the assumption that SSRF alleviates respiratory problems and the feeling that surgeons are supported by colleagues for SSRF. Non-surgeons and residents reported more and several different barriers than surgeons (surgeons: 14; non-surgical physicians: 20; residents: 21; p < 0.001).ConclusionFor adequate implementation of SSRF in patients with multiple rib fractures, implementation strategies should address the identified barriers. Especially, improved clinical experience and scientific knowledge of healthcare professionals, and high-level evidence on the (cost-) effectiveness of SSRF potentially increase its use and acceptance.

SURGICAL RIB FRACTURE FIXATION IN THE NORTH OF SCOTLAND: EARLY OPERATIVE INTERVENTION IMPROVES OUTCOMES

This study aimed to assess the outcomes of patients with complex rib fractures undergoing operative or non-operative management at our center over a six-year time period.Retrospective analysis was performed to identify all patients with complex rib fractures at our center from May 2016 to September 2022. Outcome measures included mechanical ventilation, tracheostomy, pneumonia, and mortality at one year.388 patients with complex rib fractures were identified. 37 (10%) patients fulfilled criteria for surgical management and underwent rib fracture fixation; 351 patients were managed non-operatively with anaesthetic block or analgesia alone. The fixation group had a significantly higher proportion of patients with flail chest (30 (81%) vs 94 (27%), p&lt;0.001) and were significantly more likely to require ICU admission (30 (81%) vs. 16 (5%), p&lt;0.001) than the non-operative group. At one year follow-up, no significant differences were seen for mortality between these groups (1 (3%) vs. 27 (7%), p=0.276).Of the surgical management group, those that underwent fixation &lt;72 hours post injury were significantly less likely to develop pneumonia than those who were delayed &gt;72 hours (2 (18%) vs 15 (58%), p=0.038), with downward trends noted for ICU length of stay (6 vs 10 days, p=0.140) and duration of mechanical ventilation (5 vs 8 days, p=0.177); no significant differences were seen for tracheostomy (3 vs. 5, p=0.588) or mortality (0 vs 1, p=0.856).Surgical fixation of complex rib fractures improves outcomes in selected patient groups. Early surgical fixation led to reduced rates of pneumonia and may improve other outcome measures.

Rib Plating Outcomes in Elderly Trauma Patients With Multiple Rib Fractures: A Community Hospital Experience.

Rib fractures in the elderly are one of the most common injuries in trauma patients admitted to the hospital, accounting for over 350,000 patients annually in the United States. Rib plating has been shown to be most beneficial among certain populations. Early surgical intervention is important to utilize approaches that limit the use of pain medications. This is a retrospective data analysis to determine the efficacy of rib plating in elderly trauma patients with rib fractures. A total of 253 patients were seen with rib fractures, 63% were male and 37% were female. The mean age is 64 ± 18.5years. Of these patients analyzed, 76% had an associated comorbid condition. A majority of patients (95%) presented to the emergency department (ED) with mild GCS range (13-15). Moderate GCS range (9-12) was 4%, and 3% of patients were with severe GCS (3-8.) The mean ISS was 10. The overall mortality rate was 4.5%. Patients were divided into 2 groups: group I consisted of patients who received open reduction and fixation of the fractured ribs, and group II was patients managed conservatively without surgery. Statistical analyses using Student's t-test and Chi-square test were performed. Institutional Review Board approval was obtained for this study. Rib plating in elderly trauma patients with multiple rib fractures has shown to be beneficial in terms of mortality. Furthermore, geriatric patients with comorbidities will benefit from early open reduction and fixation of rib fractures, though a larger study is needed to establish clearer criteria for rib plating.