Traumatic thoracic rib cage hernias: Operative management and proposal for a new anatomic-based grading system

Area of Science:

• Trauma Surgery
• Thoracic Surgery
• Surgical Management

Background:

• Traumatic Rib Cage Hernias (TRCH) requiring operative repair are rare.
• No established literature guides surgical management for TRCH.

Purpose of the Study:

• To develop and evaluate a grading system for surgical management of TRCH.
• To analyze perioperative outcomes of TRCH repair.

Main Methods:

• A 32-year perioperative review of TRCH cases.
• Development of five operative grades based on injury extent, size, and location.
• Analysis of surgical interventions, including mesh and rib plating.

Main Results:

• Twenty-four patients underwent operative repair for TRCH (20 blunt, 4 penetrating).
• Lung herniation occurred in 88%, with a median of 4 rib fractures.
• Mesh (75%) and rib plating (79%) were commonly used; 10% required complex flap reconstruction.
• 88% maintained range of motion, and 79% returned to pre-injury activity levels.

Conclusions:

• Injury severity dictates optimal surgical management for TRCH.
• The developed operative grades effectively guide surgical care for these complex injuries.
• Most patients achieve good functional recovery, though some experience persistent pain.