Rib fracture management: A review of surgical stabilization, regional analgesia, and intercostal nerve cryoablation

Stopenski, Stephen; Binkley, Jana; Schubl, Sebastian; Bauman, Zachary M.

doi:10.1016/j.sipas.2022.100089

Cited by 6 publications

(12 citation statements)

References 79 publications

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Section: Discussionmentioning

confidence: 99%

“…Our study demonstrates a much lower hardware infection rate with almost four times more patients. One possible explanation for this is the surgical technique for SSRF has evolved substantially over the past decade [ 11 ]. With the development of the muscle-sparing technique as well as utilization of incisions uniquely placed over the rib fracture patterns, smaller incisions and less chest wall tissue damage from the surgery itself have been the result [ 11 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…One possible explanation for this is the surgical technique for SSRF has evolved substantially over the past decade [ 11 ]. With the development of the muscle-sparing technique as well as utilization of incisions uniquely placed over the rib fracture patterns, smaller incisions and less chest wall tissue damage from the surgery itself have been the result [ 11 , 21 ]. This has likely contributed to decreased rates of hardware infection.…”

Section: Discussionmentioning

confidence: 99%

“…All SSRF procedures were completed by trauma surgeons using a muscle-sparing technique, which has now been recognized as the standard of care for this procedure given it minimizes additional damage to the chest wall soft tissue [ 11 , 21 ]. Titanium plates were utilized for all procedures.…”

Section: Methodsmentioning

confidence: 99%

“…Surgical Stabilization of Rib Fractures (SSRF) is a relatively new, emerging, and evolving therapy for the treatment of traumatic rib fractures. The benefits are well-publicized and include decreased pain and narcotic utilization, decreased incidence of pneumonia and respiratory failure, decreased need for a tracheostomy, decreased intensive care unit (ICU) length of stay (LOS), decreased hospital LOS (HLOS), and decreased mortality [4,[7][8][9][10][11]. Despite the demonstrated benefits of SSRF, there still remains hesitancy to utilize this treatment modality, likely due to a paucity of literature regarding SSRF complications, especially those related to hardware infection.…”

Section: Introductionmentioning

confidence: 99%

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Hardware Infection From Surgical Stabilization of Rib Fractures Is Lower Than Previously Reported

Bauman¹,

Sutyak²,

Daubert³

et al. 2023

Cureus

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Surgical stabilization of rib fractures (SSRF) is an emerging therapy for the treatment of patients with traumatic rib fractures. Despite the demonstrated benefits of SSRF, there remains a paucity of literature regarding the complications from SSRF, especially those related to hardware infection. Currently, literature quotes hardware infection rates as high as 4%. We hypothesize that the hardware infection rate is much lower than currently published. MethodsThis is an IRB-approved, four-year multicenter descriptive review of prospectively collected data from January 2016 to June 2022. All patients undergoing SSRF were included in the study. Exclusion criteria included those patients less that 18 years of age. Basic demographics were obtained: age, gender, Injury Severity Score (ISS), Abbreviate Injury Scale-chest (AIS-chest), flail chest (yes/no), delayed SSRF more than two weeks (yes/no), number of patients with a pre-SSRF chest tube, and number of ribs fixated. Primary outcome was hardware infection. Secondary outcomes included mortality rate and hospital length of stay (HLOS). Basic descriptive statistics were utilized for analysis. ResultsA total of 453 patients met criteria for inclusion in the study. Mean age was 63 ± 15.2 years and 71% were male. Mean ISS was 17.3 ± 8.5 with a mean AIS-chest of 3.2 ± 0.5. Flail chest (three consecutive ribs with two or more fractures on each rib) accounted for 32% of patients. Forty-two patients (9.3%) underwent delayed SSRF. The average number of ribs stabilized was 4.75 ± 0.71. When analyzing the primary outcome, only two patients (0.4%) developed a hardware infection requiring reoperation to remove the plates. Overall HLOS was 10.5 ± 6.8 days. Five patients suffered a mortality (1.1%), all five with ISS scores higher than 15 suggesting significant polytrauma. ConclusionThis is the largest case series to date examining SSRF hardware infection. The incidence of SSRF hardware infection is very low (<0.5%), much less than quoted in current literature. Overall, SSRF is a safe procedure with low morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Hardware Infection From Surgical Stabilization of Rib Fractures Is Lower Than Previously Reported

Bauman¹,

Sutyak²,

Daubert³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

Prognostic factors for outcomes following surgical stabilization of rib fractures: A review of the literature

Fitzpatrick,

Lampridis,

Gangadharan

et al. 2024

Injury

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

Bauman,

Khan,

Cavlovic

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND Surgical stabilization of rib fractures (SSRF) 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. METHODS This is a retrospective review of patients presenting to our level 1 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 (pre- and post-operatively), intensive care unit (ICU) and hospital length of stay (LOS), and resolution of pre-operative symptoms, specifically chest wall instability, with return to activities of daily living (ADLs). RESULTS Forty-four patients met inclusion criteria with a total of 156 symptomatic nonunion rib fractures and received delayed SSRF. The average age was 59.2 ± 11.9 years and median number of days from injury to SSRF was 172.5 (IQR 27.5,200). The average number rib fractures plated per patient 3.5 ± 1.8. Only 3 patients required ICU admission post-operatively for no longer than 2 days. Median hospital LOS was 2 (IQR 1,3) days. Average pre- and post-operative pain score was 6.8 ± 1.9 and 2.02 ± 1.5, respectively (p < 0.001). Chest wall instability and pre-operative symptoms resolved in 93.2% of patients post-operatively (p < 0.001). Two patients (4.5%) had postoperative complications which resolved after additional surgical intervention. Rib fracture healing was demonstrated on radiographic imaging during post-operative follow-up. CONCLUSION Delayed SSRF is safe and demonstrates significant resolution of pre-operative symptoms by decreasing pain, improving chest wall stability and allowing patients to return to activities of daily living. LEVEL OF EVIDENCE Therapeutic Level IV

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Rib fracture management: A review of surgical stabilization, regional analgesia, and intercostal nerve cryoablation

Cited by 6 publications

References 79 publications

Hardware Infection From Surgical Stabilization of Rib Fractures Is Lower Than Previously Reported

Hardware Infection From Surgical Stabilization of Rib Fractures Is Lower Than Previously Reported

Prognostic factors for outcomes following surgical stabilization of rib fractures: A review of the literature

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

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