Intrathoracic surgical stabilization of rib fractures: What you need to know

Rib fractures remain among the most common injuries in trauma patients. The past two decades have seen a sharp increase in the scientific study of chest wall injury and the development of multiple dedicated rib stabilization systems, including some that are deployable intrathoracically. Beyond repair of fractured ribs, chest wall injury also includes management of other intrathoracic pathologies that can make the addition of video-assisted thoracoscopy to chest wall surgery prudent. Indications for rib fracture surgery have been published by numerous surgical societies despite ongoing debate though none recommend one repair system or approach over another. Early and complete clearance of the chest space at the time of surgery, when surgical stabilization is indicated, has shown benefit in patients with severe chest wall trauma. The recent availability of a second-generation intrathoracic system with novel suture and knot-based fixation increases the options for chest wall surgeons when considering surgical repair. This review summarizes the understanding of intrathoracic surgical stabilization to date and the scenarios where surgical clearance of the chest space is potentially worthwhile. Additional considerations, timing, limitations, and infectious concerns are reviewed in the hopes of providing the reader with what they need to know on the topic.