Is it Necessary to Stabilize Every Fracture in Patients with Serial Rib Fractures in Blunt Force Trauma?

Area of Science:

• Trauma surgery
• Thoracic surgery
• Orthopedic surgery

Background:

• Traumatic rib fractures are common, often resulting from accidents.
• Management strategies for rib fractures lack consensus, with varying approaches to surgical stabilization.
• Conservative treatments may not be effective for all patients, necessitating alternative interventions.

Purpose of the Study:

• To evaluate the efficacy of intraoperative assessment in guiding surgical stabilization of traumatic rib fractures.
• To determine the criteria for osteosynthesis in patients with chest wall trauma.
• To assess the outcomes of chest wall stabilization in a cohort of patients.

Main Methods:

• A retrospective analysis of 121 chest wall stabilization procedures performed between 07/2016 and 07/2021.
• Indications for surgery included palpable instability, dislocated fractures, concomitant injuries, and uncontrollable pain.
• Preoperative computed tomography (CT) scans and intraoperative video-assisted thoracoscopy were utilized for assessment.

Main Results:

• An average of 6.3 rib fractures were detected per patient, with 2.4 ribs treated osteosynthetically.
• Intraoperative assessment identified relevant fractures, guiding precise osteosynthesis.
• Complications included post-operative bleeding (5.8%) and material breakage (1.7%).

Conclusions:

• Intraoperative assessment and thoracoscopy are crucial for identifying relevant rib fractures and concomitant injuries, guiding surgical decision-making.
• Osteosynthesis should be selectively applied to unstable or significantly displaced fractures, not necessarily all fractures.
• Successful chest wall stabilization, combined with adequate analgesia and respiratory support, is essential for managing thoracic trauma.