Pain as an indication for rib fixation: a bi-institutional pilot study

Area of Science:

• Trauma Surgery
• Orthopedic Surgery
• Critical Care Medicine

Background:

• Open reduction and internal fixation (ORIF) for rib fractures is controversial in trauma care.
• Hypothesized benefits include reduced pain, lower opiate use, fewer pulmonary complications, and shorter hospital stays.

Purpose of the Study:

• To evaluate the effectiveness of ORIF for rib fractures in managing pain and improving patient outcomes.
• To compare opiate requirements, pulmonary complications, and length of stay between patients undergoing ORIF and matched controls.

Main Methods:

• Retrospective, bi-institutional, matched case-control study.
• Cases (ORIF) were matched 1:2 with controls based on injury severity scores and fracture characteristics.
• Primary outcome was inpatient narcotic administration, converted to equianalgesic morphine doses.

Main Results:

• ORIF patients showed a significant decrease in morphine requirements from pre- to post-operative periods (p=0.01).
• No significant differences were found between ORIF cases and controls in mean morphine dose, hospital stay, ICU stay, ventilation days, or pneumonia rates.

Conclusions:

• Rib fixation significantly reduced the need for analgesia post-surgery in patients with multiple rib fractures.
• This pilot study did not demonstrate significant differences in overall outcomes compared to matched controls, suggesting further investigation is needed.