Building an Integrated Trauma-Orthopedic Chest Wall Injury Service: Implementation, Workflow, and Early Experience...

Presented herein is a novel concept of a chest wall injury service to manage surgical stabilization of rib fractures (SSRF). This chest wall injury service encompasses the strength of two respective surgical services, trauma and orthopedics, into a structured clinical pathway emphasizing early identification, multidisciplinary decision-making, and coordinated operative care. At our site, patients with rib fractures undergo standardized physiologic assessment using Pain, Inspiratory volume, and Cough (PIC) score along with radiographic evaluation. The model involves the team, consisting of both trauma and orthopedic surgeons, performing joint evaluation and determination of candidacy for SSRF as well as operative and postoperative management. Since implementation in June 2024, the pathway has managed 35 patients undergoing SSRF, demonstrating successful integration of multidisciplinary evaluation, protocolized triage, and joint operative workflow. The model aligns with emerging literature and provides a reproducible framework for standardizing care delivery in patients with complex chest wall injury.