Surgical Rib Fixation is Associated With Lower Mortality in Patients With Traumatic Rib Fractures
Kerwin X Cruz-De La Rosa1, Ediel O Ramos-Meléndez1, Pedro E Ruiz-Medina1
1Department of Surgery, Trauma Research Program, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
The Journal of Surgical Research
|December 16, 2023
Summary
Surgical rib fixation for traumatic rib fractures may reduce mortality, especially in severe cases with multiple fractures or flail segments. This approach, while potentially increasing hospital stay, shows promise for selected patients needing intervention beyond nonoperative management.
Area of Science:
- Trauma Surgery
- Thoracic Surgery
- Surgical Outcomes Research
Background:
- Nonoperative management (NOM) is standard for traumatic rib fractures.
- Surgical rib fixation is an emerging treatment, but guidelines are lacking.
- This study addresses the need for evidence-based treatment strategies.
Purpose of the Study:
- To compare outcomes and complications of surgical rib fixation versus NOM for traumatic rib fractures.
- To identify patient subgroups that may benefit from surgical intervention.
- To inform treatment strategies for traumatic rib fractures.
Main Methods:
- Retrospective cohort study at Puerto Rico Trauma Hospital (Jan 2016 - Jul 2020).
- Compared 50 surgically treated patients with 150 NOM patients.
- Outcomes analyzed using negative binomial and logistic regressions.
Main Results:
- Operative group had higher prevalence of flail segment, more fractures, and displaced fractures.
- Surgical fixation was associated with an 85% lower mortality rate.
- Hospital length of stay was 25% longer in the surgical group.
Conclusions:
- Rib fixation may benefit selected patients with severe traumatic rib fractures.
- Indications include bilateral fractures, multiple displaced fractures, flail segments, and thoracic injuries.
- This study provides guidance for surgical management and patient selection.
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