Isolated Thoracic Injury Patients With Rib Fractures Undergoing Rib Fixation Have Improved Mortality

Yeates, Eric O; Grigorian, Areg; Nahmias, Jeffry; Dolich, Matthew; Lekawa, Michael; Qazi, Alliya; Kong, Allen; Schubl, Sebastian

doi:10.1016/j.jss.2021.01.016

Cited by 6 publications

(2 citation statements)

References 33 publications

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“…Furthermore, a good quality of life at least one year after surgery and adequate pulmonary function were seen after rib fixation, in both flail chest and non-flail multiple rib fracture patients [ 34 , 35 ]. An extensive retrospective cohort study on the effect of rib fixation in patients with isolated thoracic injuries with rib fractures also showed that rib fixation was significantly associated with lower mortality rates, yet this association was not analyzed separately for patients with flail chests or non-flail rib fractures [ 36 ]. Several indications for rib fixation have been established, such as flail chests, reduction of pain and disability, chest wall deformity, respiratory failure, non-union, and open rib fractures [ 6 , 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of combined clavicle and rib fractures: a systematic review

Sweet

Beks

IJpma

et al. 2021

Eur J Trauma Emerg Surg

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Purpose The aim of this systematic review was to provide an overview of the incidence of combined clavicle and rib fractures and the association between these two injuries. Methods A systematic literature search was performed in the MEDLINE, EMBASE, and CENTRAL databases on the 14th of August 2020. Outcome measures were incidence, hospital length of stay (HLOS), intensive care unit admission and length of stay (ILOS), duration of mechanical ventilation (DMV), mortality, chest tube duration, Constant–Murley score, union and complications. Results Seven studies with a total of 71,572 patients were included, comprising five studies on epidemiology and two studies on treatment. Among blunt chest trauma patients, 18.6% had concomitant clavicle and rib fractures. The incidence of rib fractures in polytrauma patients with clavicle fractures was 56–60.6% versus 29% in patients without clavicle fractures. Vice versa, 14–18.8% of patients with multiple rib fractures had concomitant clavicle fractures compared to 7.1% in patients without multiple rib fractures. One study reported no complications after fixation of both injuries. Another study on treatment, reported shorter ILOS and less complications among operatively versus conservatively treated patients (5.4 ± 1.5 versus 21 ± 13.6 days). Conclusion Clavicle fractures and rib fractures are closely related in polytrauma patients and almost a fifth of all blunt chest trauma patients sustain both injuries. Definitive conclusions could not be drawn on treatment of the combined injury. Future research should further investigate indications and benefits of operative treatment of this injury.

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Section: Discussionmentioning

confidence: 99%

Epidemiology of combined clavicle and rib fractures: a systematic review

Sweet

Beks

IJpma

et al. 2021

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

show abstract

“…While surgical RF has demonstrated improved patient outcomes in recent studies [7,[11][12][13][14][15][16][17][18][19][20], questions regarding the benefit in the obese trauma patient have remained unanswered. To our knowledge, this is the first study to specifically evaluate outcomes in obese patients undergoing RF for flail chest.…”

Section: Commentmentioning

confidence: 99%

Surgical Rib Fixation in Obese Patients with Isolated Flail Chest Improves Outcomes: A Matched Cohort Study

et al. 2022

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Background Obesity is associated with adverse outcomes after major operations. The role of operative rib fixation (RF) in obese patients with flail chest is not clear. The presence of other associated injuries may complicate the interpretation of outcomes. This study compared outcomes after RF to nonoperative management (NOM) in obese patients with isolated flail chest injury. Methods Adult obese patients (BMI > 29.9) with flail chest were identified from the Trauma Quality Improvement Program (TQIP) database (2016–2018). Hospital transfers, death within 72 h, and extrathoracic injuries were excluded. RF patients were propensity score matched (1:2) to similar NOM patients. Multivariate regression identified independent factors predicting adverse outcomes. Results Overall, 367 patients with isolated flail chest who underwent RF were matched with 734 in the NOM group. After matching, the mortality rate was significantly lower in the RF group (1.4% vs. 3.7%; p < 0.05). RF had longer HLOS (15.7 days vs. 12.8 days; p < 0.05) and ICU LOS (10.1 days vs. 8.6 days; p < 0.05), shorter ventilator days (9.2 days vs. 11.5 days; p < 0.05), and a higher rate of venous thromboembolism (7.1% vs. 3.5%, p < 0.05). On multivariate analysis, RF was associated with decreased mortality (OR 0.27; p < 0.05). Early RF (≤ 72 h) was associated with shorter ICU stay and mechanical ventilation. Conclusion RF for isolated flail chest in obese patients is associated with decreased mortality and fewer ventilator days. When performed early, fixation decreases the need for prolonged ventilator use and ICU stay. A more aggressive VTE prophylaxis should be considered in patients undergoing RF.

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Does the timing of surgery affect outcomes in young and middle-aged patients undergoing surgical stabilization of rib fractures? Feedback was based on real data from physicians, patients, and family caregivers

Wang

Jing

et al. 2023

Eur J Trauma Emerg Surg

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Isolated Thoracic Injury Patients With Rib Fractures Undergoing Rib Fixation Have Improved Mortality

Cited by 6 publications

References 33 publications

Epidemiology of combined clavicle and rib fractures: a systematic review

Epidemiology of combined clavicle and rib fractures: a systematic review

Surgical Rib Fixation in Obese Patients with Isolated Flail Chest Improves Outcomes: A Matched Cohort Study

Does the timing of surgery affect outcomes in young and middle-aged patients undergoing surgical stabilization of rib fractures? Feedback was based on real data from physicians, patients, and family caregivers

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