Surgical rib fixation: review of current indications and proposal of future implementations
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Traumatic rib fractures are common in blunt force trauma and present numerous complications. These fractures are caused by excessive force to the chest wall in scenarios such as car accidents, falls, and assaults, as well as penetrating injuries. Rib fractures are extremely prevalent in blunt thoracic trauma, as 2/3 of patients involved in motor vehicle accidents present with fractures.1 The number of rib fractures directly correlates with an increase in morbidity and mortality and it is recommended that patients with 3 or more rib fractures be hospitalized.2 Flail chest involves 3 or more ribs fractured in two or more places resulting in a floating segment and paradoxical movement with inspiration.3 This abnormal breathing pattern can compromise respiratory effort, increase the work of breathing, and necessitate intubation and ventilator support. Both flail chest and multiple rib fractures are associated with numerous complications including pneumonia, respiratory failure, fracture non-union (non-healing fractures), and chronic disability.4 Standard conservative treatment for multiple severe rib fractures and flail chest includes pain control and pulmonary care and support. Numerous studies have found an increase in hospital stay, time on a mechanical ventilator, and worse long-term outcomes with conservative management.5 6 In recent years surgical rib fixation has become increasingly popular at specific trauma centers around the world, although no current guidelines exist for when to perform the procedure, who would benefit the most, and which surgical approach should be utilized. Some recent research indicates there may be a benefit of surgical rib fixation in regards to long-term outcomes, initial recovery, and hospital stay. The goal of this paper is to evaluate the current randomized controlled trials comparing surgical rib fixation and other conservative treatment methods to determine if there is a quantifiable benefit of surgery, when it can be implemented, and in what population it should be utilized. A study will be proposed to further evaluate the effectiveness and implementation of surgical rib fixation for multiple traumatic rib fractures.