Surgical fixation of rib fractures: how I do it

Abstract

Chest wall trauma is common worldwide. The majority of cases are a result of blunt mechanisms. Among these injuries, rib fractures are considered the most frequent type of clinically significant blunt thoracic trauma sequelae and are associated with considerable morbidity and mortality. Despite a large number of cases annually, there are no internationally recognized guidelines for rib fracture treatment yet. This controversy in treatment options can be attributed to the lack of high-level convincing clinical research that confirms the benefits of surgical treatment over conservative treatment measures. Over the last 100 years, rib fixation has been carried out infrequently using non-specific materials due to lack of specific rib fixation systems. However, a substantial advancement in materials (e.g., low profile titanium plates) and technologies (e.g., angle-stable locking screws) was achieved in the last decade. Despite these developments, so far no clinical study has proven the superiority of one system over another. In this article, we would like to share our experience in this field including indications for surgical rib fixation and how we perform such procedures.

Surgical rib fixation as an alternative method of treatment for multiple rib fractures: an audit of results compared with traditional medical management

“…3,5,6 Over the years, multiple publications have demonstrated a clear reduction in the need for opioid analgesia, incidence of pneumonia, shorter ventilation times and ICU stay and generally, a better outcome when surgery was offered over BMT. 1,2,5,6,10,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Unfortunately, in South Africa, not all patients have access to all of the BMT strategies, including options in advanced pain management.…”

“…Adequate analgesia, chest physiotherapy and early skeletal (rib) fixation seems to prevent complications, as stated in several recent studies. 1,2,13,[15][16][17]19,21…”

“…Rib fractures are common and causations are multifactorial; they are a recognised marker for severity of injury and a significant cause of in-hospital morbidity, chronic pain, and delays in return to normal activities. [1][2][3] The number of ribs fractured, presence of flail segment, patient age, associated lung trauma and extra thoracic injuries, especially traumatic brain injury are predictors of outcome. [1][2][3][4][5][6][7][8][9][10] The current standard of care for rib fractures is nonoperative and is based on several key components.…”

“…[1][2][3] The number of ribs fractured, presence of flail segment, patient age, associated lung trauma and extra thoracic injuries, especially traumatic brain injury are predictors of outcome. [1][2][3][4][5][6][7][8][9][10] The current standard of care for rib fractures is nonoperative and is based on several key components. These include appropriate oxygenation, management of respiratory failure with mechanical ventilation, lung re-expansion techniques, appropriate management of pain, removal of secretions and aggressive chest physiotherapy.…”

“…These include appropriate oxygenation, management of respiratory failure with mechanical ventilation, lung re-expansion techniques, appropriate management of pain, removal of secretions and aggressive chest physiotherapy. [1][2][3][4][5][6][7][8][9][10] Unfortunately, non-operative management addresses only the pathophysiological component of this problem, while the mechanical and anatomical problems (actual fractures) are usually overlooked and treated with options that are not designed to facilitate bone consolidation.…”