Early Versus Late Rib Fixation in Patients With Traumatic Rib Fractures: A Nationwide Study

Otaka, Shunichi; Aso, Shotaro; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo

doi:10.1016/j.athoracsur.2020.03.084

Cited by 22 publications

(11 citation statements)

References 24 publications

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“…While only the first study was available at the time of developing these guidelines, the more recently published studies corroborate this consensus of early SSRF benefit (75,(78)(79)(80)(82)(83)(84)89). In addition, early SSRF appears to be safe and also beneficial in elderly patients for all outcomes and is associated with lower hospitalization costs (80,83,84). Interestingly, recent studies have also suggested that while early fixation within 2-3 days after admission is associated with improved in-hospital outcomes, performing SSRF after this time period might actually correlate with outcomes inferior to nonoperative management (81,82).…”

Section: Commentsmentioning

confidence: 90%

“…The next study was a retrospective national database study of the same time period and patient population as the previous study (83). In this study (n=211), patients who underwent SSRF were stratified based on the median time to SSRF in ≤6 and >6 days (no range given) following admission.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Current practice management guidelines for SSRF both advocate early operative fixation (≤72 hours, once other lifethreatening injuries have been identified and stabilized) to reduce HLOS, ICU-LOS, DMV, and rate of mechanical ventilation requirement, pneumonia, and tracheostomy (36,37). While only the first study was available at the time of developing these guidelines, the more recently published studies corroborate this consensus of early SSRF benefit (75,(78)(79)(80)(82)(83)(84)89). In addition, early SSRF appears to be safe and also beneficial in elderly patients for all outcomes and is associated with lower hospitalization costs (80,83,84).…”

Section: Commentsmentioning

confidence: 99%

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What is the optimal timing to perform surgical stabilization of rib fractures?

Prins

Wijffels²,

Pieracci

2021

J Thorac Dis

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The practice of surgical stabilization of rib fractures (SSRF) for severe chest wall injury has exponentially increased over the last decade due to improved outcomes as compared to nonoperative management. However, regarding in-hospital outcomes, the ideal time from injury to SSRF remains a matter of debate. This review aims to evaluate and summarize currently available literature related to timing of SSRF. Nine studies on the effect of time to SSRF were identified. All were retrospective comparative studies with no detailed information on why patients underwent early or later SSRF. Patients underwent SSRF most often for a flail chest or ≥3 displaced rib fractures. Early SSRF (≤48-72 hours after admission) was associated with shorter hospital and intensive care unit length of stay (HLOS and ICU-LOS, respectively), duration of mechanical ventilation (DMV), and lower rates of pneumonia, and tracheostomy as well as lower hospitalization costs. No difference between early or late SSRF was demonstrated for mortality rate. As compared to nonoperative management, late SSRF (>3 days after admission), was associated with similar or worse in-hospital outcomes. The optimal time to perform SSRF in patients with severe chest wall injury is early (≤48-72 hours after admission) and associated with improved in-hospital outcomes as compared to either late salvage or nonoperative management. These data must however be cautiously interpreted due the retrospective nature of the studies and potential selection and attrition bias. Future research should focus on both factors and pathways that allow patients to undergo early SSRF.

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Section: Commentsmentioning

confidence: 90%

Section: Literature Reviewmentioning

confidence: 99%

Section: Commentsmentioning

confidence: 99%

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What is the optimal timing to perform surgical stabilization of rib fractures?

Prins

Wijffels²,

Pieracci

2021

J Thorac Dis

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“…Additionally, Majak and Naess stated that SSRF within the first 72 h might lead to a better outcome ( 28 ). The Japanese group around Otaka was able to demonstrate an association of a better in-hospital outcome for early surgical fixations, whereas later surgical fixation was not ( 29 , 30 ). The first review article discussing early vs. late SSRF was published by Radomski and Pieracci in 2019, stating that an early SSRF within 72 h should be achieved but was only based on three publications at this point of time ( 31 ).…”

Section: Discussionmentioning

confidence: 97%

Impact of Time of Surgery on the Outcome after Surgical Stabilization of Rib Fractures in Severely Injured Patients with Severe Chest Trauma—A Matched-Pairs Analysis of the German Trauma Registry

et al. 2022

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PurposeIn severely injured patients with multiple rib fractures, the beneficial effect of surgical stabilization is still unknown. The existing literature shows divergent results, and the indication and especially the right timing of an operation are the subject of a broad discussion. The aim of this study was to determine the influence of the time point of surgical stabilization of rib fractures (SSRF) on the outcome in a multicenter database with special regard to the duration of ventilation, intensive care, and overall hospital stay.MethodsData from the TraumaRegister DGU collected between 2010 and 2019 were used to evaluate patients above 16 years of age with severe rib fractures [Abbreviated Injury Score (AIS) ≥ 3] who received an SSRF in a matched-pairs analysis. In this matched-pairs analysis, we compared the effects of an early SSRF within 48 h after initial trauma vs. late SSRF 3–10 days after trauma.ResultsAfter the selection process, we were able to find 142 matched pairs for further evaluation. Early SSRF was associated with a significantly shorter length of stay in the intensive care unit (16.2 days vs. 12.7 days, p = 0.020), and the overall hospital stay (28.5 days vs. 23.4 days, p = 0.005) was significantly longer in the group with late SSRF. Concerning the days on mechanical ventilation, we were able to demonstrate a trend for an approximately 1.5 day shorter ventilation time for patients after early SSRF, although this difference was not statistically significant (p = 0.226).ConclusionsWe were able to determine the significant beneficial effects of early SSRF resulting in a shorter intensive care unit stay and a shorter length of stay in hospital and additionally a trend to a shorter time on mechanical ventilation.

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“…The timing of surgical stabilization in patients with thoracic trauma also seems to have a relevant influence on the clinical outcome. A study published in 2020 by Otaka et al reported significant reductions in the duration of mechanical ventilation, the duration of hospitalization and economic expenses, provided that the rib stabilization took place a maximum of 6 days after the accident occurred ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

Is it Necessary to Stabilize Every Fracture in Patients with Serial Rib Fractures in Blunt Force Trauma?

et al. 2022

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IntroductionManagement of traumatic rib fractures is subject of controversial discussions. Rib fractures are common, especially after traffic accidents and falls. There is no consensus on whether and how many rib fractures need reconstruction. Not every rib fracture needs to be stabilized, but conservative treatment by internal splinting and analgesia is not effective for all patients. Deformities of the chest wall with reduced thoracic volume and restrictive ventilation disorders must be avoided. Intraoperative assessment of fractures and chest stability plays a central role.Material and methodsFrom 07/2016 to 07/2021, a total of 121 chest wall stabilizations were performed (m:f = 2:1, age 65 ± 14.5 a). Indications for surgery were the following criteria: (1) palpatory instability of the chest wall, (2) dislocated fracture endings, (3) concomitant injuries, (4) uncontrollable pain symptoms. In all patients, a computed tomography scan of the thorax was performed before the osteosynthetic treatment to assess dislocation of the fracture endings and possible concomitant injuries of intrathoracic organs.ResultsVideo-assisted thoracoscopy was performed in all patients. Hemothorax and concomitant injuries of the lung, diaphragm and mediastinum could be assessed. This was followed by an intraoperative assessment of the rib fractures, in particular penetration of fracture endings and resulting instability and deformity. Relevant fractures could be identified and subsequent incisions for rib osteosynthesis precisely defined. 6.3 (±2.7) rib fractures were detected, but 2.4 (±1.2) ribs treated osteosynthetically. Bilateral rib fractures were present in 26 patients (21.5%). Post-operative bleeding occurred in seven patients (5.8%), a breakage of the osteosynthetic material in two patients (1.7%).DiscussionIntraoperative assessment of relevant fractures and dislocation is the decisive criterium for osteosynthesis. Thoracoscopy is mandatory for this purpose – also to identify accompanying injuries. Not every fracture has to be approached osteosynthetically. Even with serial rib fractures or multiple fractures in a single rib, the thoracic contour can be restored by stabilizing only relevant fractures. Intraoperative palpation can adequately assess the stability and thus the result of the osteosynthesis. Even after surgical treatment of thoracic trauma, adequate analgesia and respiratory therapy are important to the healing process.

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Early Versus Late Rib Fixation in Patients With Traumatic Rib Fractures: A Nationwide Study

Cited by 22 publications

References 24 publications

What is the optimal timing to perform surgical stabilization of rib fractures?

What is the optimal timing to perform surgical stabilization of rib fractures?

Impact of Time of Surgery on the Outcome after Surgical Stabilization of Rib Fractures in Severely Injured Patients with Severe Chest Trauma—A Matched-Pairs Analysis of the German Trauma Registry

Is it Necessary to Stabilize Every Fracture in Patients with Serial Rib Fractures in Blunt Force Trauma?

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