Surgical Stabilization Improves Rib Fracture Outcomes

Surgical stabilization of rib fracture (SSRF) improves outcomes of patients with displaced rib fractures in the absence of flail chest, claims a new study.

Denver Health Medical Center (CO, USA), Baystate Medical Center (Springfield, MA, USA), and other institutions conducted a prospective, controlled, clinical trial in 12 centers comparing SSRF within 72 hours to medical management in 110 patients with three or more ipsilateral, severely displaced rib fractures, but without flail chest; of these, 51 (46.4%) underwent SSRF. The main outcome was numeric pain score (NPS) at two-week follow-up. Narcotic consumption, spirometry, pulmonary function tests, pleural space complications, and overall and respiratory disability-related quality of life were also compared.

The results showed that there were no significant baseline differences between operative and non-operative groups. At two week follow-up, the NPS was significantly lower in the operative (2.9) than in the non-operative group (4.5), and respiratory disability-related quality of life was also significantly improved. Narcotic consumption trended toward being lower in the operative, as compared with the non-operative group. During index admission, pleural space complications were significantly lower in the operative (0%), than in the non-operative group (10.2%). The study was published on February 5, 2020, in the Journal of Trauma and Acute Care Surgery.

“We demonstrated a significant improvement in the primary outcome of pain at two week follow-up in patients with displaced, non-flail fracture patterns who underwent SSRF, compared with non-operative management,” concluded lead author Fredric Pieracci, MD, MPH. “These data support a role for SSRF in patients without either clinical or radiographic flail chest, with recognition of trial inclusion criteria, including evidence of pulmonary derangements due to the fractures, early surgery, and performance of the operation at an experienced center.”

Flail chest is a traumatic condition of the thorax that occurs when at least three or more ribs are broken in at least two places. The injuries cause a segment of the chest wall to move independently of the rest of the chest wall, creating significant disturbance in respiratory function, including ineffective ventilation due to increased dead space, decreased intrathoracic pressure, and increased oxygen demand; edema and pulmonary contusion; and hypoventilation with atelectasis.

Related Links:
Denver Health Medical Center
Baystate Medical Center