Local Injection of Hyaluronic Acid With Platelet-Rich Plasma for Partially Displaced Rib Fractures

Nonsurgical management is the standard treatment for bicortical rib fractures without total displacement. Notably, such fractures are often associated with severe pain and thoracic trauma complications, including progressive pneumothorax, hemothorax, and total displacement of fractured ribs. The efficacy and safety of local injection with hyaluronic acid combined with platelet-rich plasma (HAPRP) at fracture sites remain unclear.

This study included 56 patients with multiple bicortical partially displaced rib fractures caused by blunt chest trauma (June 2023 to February 2024). Of these patients, 18 received local HAPRP injection (group 1), and 38 received standard care (group 2). Data were collected regarding demographic characteristics, total analgesic doses, length of hospital stay, and thoracic trauma complications during treatment.

Group 1 required significantly fewer oral opiates and nonsteroidal anti-inflammatory drugs than did group 2-16.5 (10.0-19.0) versus 25.5 (18.5-31.0) mg, P = 0.001; 9.0 (4.0-21.5) versus 14.5 (7.0-24.0) days, P = 0.002. The complication rate was significantly lower in group 1 (22.2% versus 55.3%, P = 0.020). Hospital stay was significantly shorter in group 1 than in group 2-9.0 (7.5-11.3) versus 11.0 (10-14.8) days, P = 0.001. Baseline severity, including rib fracture count, lung contusion score, and injury severity score, did not significantly differ between the groups.

Partially displaced bicortical rib fractures caused by blunt chest trauma are frequently associated with severe pain and an increased risk of thoracic trauma complications due to chest wall instability. Local HAPRP injection was associated with a lower requirement for analgesics, fewer secondary complications, and shorter hospital stay, suggesting potential benefits.