Rib fracture fixation in the 65 years and older population

Fitzgerald, Michael T.; Ashley, Dennis W.; Abukhdeir, Hesham; Christie, D. Benjamin

doi:10.1097/ta.0000000000001330

Cited by 75 publications

(43 citation statements)

References 10 publications

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“…Encouraged by favorable results with regard to ventilator days and risk of complications after surgical rib fixation in patients with flail chest as shown in the randomized trial by Marasco et al, some have advocated surgical rib fixation in the elderly patient with multiple (non flail chest) rib fractures too [13, 14]. A recent retrospective case control study by Fitzgerald et al supports this strategy; surgical rib fixation was associated with lower rates of pneumonia, respiratory readmissions in ICU and death [15, 16].…”

Section: Discussionmentioning

confidence: 99%

Patterns of injury and outcomes in the elderly patient with rib fractures: a multicenter observational study

Vledder

Kwakernaak

Hagenaars

et al. 2018

Eur J Trauma Emerg Surg

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Section: Discussionmentioning

confidence: 99%

Patterns of injury and outcomes in the elderly patient with rib fractures: a multicenter observational study

Vledder

Kwakernaak

Hagenaars

et al. 2018

Eur J Trauma Emerg Surg

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“…As only two studies, both retrospective cohort studies with small sample sizes and short follow-up, have singularly focused on operative versus nonoperative management of multiple simple rib fractures, definitive proof for the optimal treatment of multiple simple rib fractures is not achieved yet [9, 14, 39–41].…”

Section: Introductionmentioning

confidence: 99%

Early fixation versus conservative therapy of multiple, simple rib fractures (FixCon): protocol for a multicenter randomized controlled trial

et al. 2019

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Background Multiple rib fractures are common injuries in both the young and elderly. Rib fractures account for 10% of all trauma admissions and are seen in up to 39% of patients after thoracic trauma. With morbidity and mortality rates increasing with the number of rib fractures as well as poor quality of life at long-term follow-up, multiple rib fractures pose a serious health hazard. Operative fixation of flail chest is beneficial over nonoperative treatment regarding, among others, pneumonia and both intensive care unit (ICU) and hospital length of stay. With no high-quality evidence on the effects of multiple simple rib fracture treatment, the optimal treatment modality remains unknown. This study sets out to investigate outcome of operative fixation versus nonoperative treatment of multiple simple rib fractures. Methods The proposed study is a multicenter randomized controlled trial. Patients will be eligible if they have three or more multiple simple rib fractures of which at least one is dislocated over one shaft width or with unbearable pain (visual analog scale (VAS) or numeric rating scale (NRS) > 6). Patients in the intervention group will be treated with open reduction and internal fixation. Pre- and postoperative care equals treatment in the control group. The control group will receive nonoperative treatment, consisting of pain management, bronchodilator inhalers, oxygen support or mechanical ventilation if needed, and pulmonary physical therapy. The primary outcome measure will be occurrence of pneumonia within 30 days after trauma. Secondary outcome measures are the need and duration of mechanical ventilation, thoracic pain and analgesics use, (recovery of) pulmonary function, hospital and ICU length of stay, thoracic injury-related and surgery-related complications and mortality, secondary interventions, quality of life, and cost-effectiveness comprising health care consumption and productivity loss. Follow-up visits will be standardized and daily during hospital admission, at 14 days and 1, 3, 6, and 12 months. Discussion With favorable results in flail chest patients, operative treatment may also be beneficial in patients with multiple simple rib fractures. The FixCon trial will be the first study to compare clinical, functional, and economic outcome between operative fixation and nonoperative treatment for multiple simple rib fractures. Trial registration www.trialregister.nl , NTR7248. Registered May 31, 2018.

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“…Due to the small sample size, this data did not reach statistical significance. It is worth noting that patient questionnaires in this study implied that rib plating was associated with decreased narcotic use, earlier absence of respiratory fatigue, and earlier lifestyle satisfaction achievement [43] . To our knowledge, there are currently 3 studies that examine long term outcomes and QOL in patients who have undergone SSRF.…”

Section: Implantsmentioning

confidence: 69%

“…In a review following rib plating versus non-operative management in patients age 65 and older, a patient population that has a well documented increased mortality rate at 20% and increased pneumonia rate at 19% [42] ; Fitzgerald et al found that those 50 patients treated non-operatively there were 4 respiratory related readmissions, 2 deaths, 7 cases of pneumonia, 7 pleural effusions, and 19 pneumothoraces compared with zero in the operatively managed group [43] . Again, the rib plating group had decreased ICU length of stay and accelerated rehabilitation compared with the injury matched control group despite having higher overall ISS scores.…”

Section: Implantsmentioning

confidence: 99%

Surgical Treatment of Flail Chest and Rib Fractures: A Systematic Review of the Literature

McClure

Myers

Triplet

et al. 2019

International Journal of Orthopaedics

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Rib fractures are relatively common injuries which are predominantly managed non-operatively. However, there has been an increasing amount of evidence over the past two decades supporting the role of surgical management in the presence of multiple rib fractures and flail chest. The purpose of this systematic review is to provide a comprehensive overview of the surgical management of flail chest and rib fractures along with outlining the relative indications, trends in surgical technique, and the evidence comparing operative versus non-operative treatment.

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Rib fracture fixation in the 65 years and older population

Abstract: Therapeutic/care management study, level IV.

Cited by 75 publications

References 10 publications

Patterns of injury and outcomes in the elderly patient with rib fractures: a multicenter observational study

Patterns of injury and outcomes in the elderly patient with rib fractures: a multicenter observational study

Early fixation versus conservative therapy of multiple, simple rib fractures (FixCon): protocol for a multicenter randomized controlled trial

Surgical Treatment of Flail Chest and Rib Fractures: A Systematic Review of the Literature

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