Treatment of traumatic rib fractures: an overview of current evidence and future perspectives

Operative management of rib fractures has gained significant popularity over the last years, however, it remains a controversial topic, due to the substantial heterogeneity among rib fracture patients with considerable differences in epidemiology. Hence, the present narrative review aims to provide an overview of the treatment and (long-term) outcomes of rib fractures, with an emphasis on the surgical treatment. Nowadays, computed tomography (CT) has been shown to be most practical and sensitive for detecting rib fractures, of which up to 50% is missed on other imaging modalities. Non-operative treatment by patient-tailored multimodal pain management remains the cornerstone. Still, in the presence of-amidst others-chest wall instability or displaced fractures with physiologic derangements, operative treatment is indicated and should be performed within 72 hours after injury. Here, traumatic brain injury (TBI) and pulmonary contusion are no strict contra-indications, while plate osteosynthesis is considered the standard mode for surgical stabilization. To date, surgical stabilization of rib fractures (SSRF) only benefits selected groups of patients, awaiting results of ongoing studies. Future directions may include the sole use of percutaneous cryoablation of the intercostal nerves as part of conservative management, as well as the application of three-dimensional (3D) printing and use of bio-absorbable materials in the surgical treatment of rib fractures.