Prosthetic-free ribs stabilization technique in critical complex chest wall traumas: first results and experiences

Mortality and Morbidity in Rib Fracture Surgery: Pulmonary Contusion Versus Extrathoracic Trauma

INTRODUCTION

This study aimed to determine whether the primary cause of morbidity and mortality in patients undergoing rib stabilization surgery due to blunt trauma-induced rib fractures is pulmonary contusion or associated extrathoracic trauma.

METHODS

Patients aged 18-80 y diagnosed with flail chest following blunt trauma and undergoing rib stabilization surgery between January 1, 2014, and January 1, 2024, were included. Collected data encompassed demographics, trauma type, associated injuries, surgery timing, mechanical ventilation, extubation time, intensive care unit stay, and morbidity/mortality outcomes. Statistical analyses were performed using Statistical Package for the Social Sciences 22.0, with a significance level of P < 0.05.

RESULTS

Among 110 patients, the mean age was 55.6 ± 13.9 y, with 80.9% being male. Early stabilization (<72 h) was performed in 77.3%, and late stabilization (>72 h) in 22.7%. Prolonged intensive care unit stays (>2 d) were observed in 52.7%, with an average hospital stay of 14.63 ± 20.17 d. Pneumonia (31.8%) was the most common morbidity, and the mortality rate was 14.5%. Pulmonary contusion (P = 0.021) and vertebral injury (P = 0.007) were significantly associated with pneumonia. Abdominal trauma increased tracheostomy rates (P = 0.038), and maxillofacial trauma was associated with mortality (P = 0.030).

CONCLUSIONS

Timely rib stabilization and a multidisciplinary approach are critical for managing thoracic injuries. Trauma severity and associated injuries significantly influence outcomes. Standardized protocols for intervention timing and patient selection may help reduce morbidity and mortality in multitrauma patients.

Suture fixation of traumatic rib fracture flail segment with Klebsiella osteomyelitis

We report the case of a 71-year-old male who initially presented with urosepsis and was found to have a rib fracture of his right 6th rib with a flail segment and an associated abscess. Given the concern for infection, surgical rib fixation with titanium plating was not pursued during the washout of his abscess and instead, he successfully underwent rib fracture stabilization with bilateral suture transfixation. He was continued on a prolonged course of antibiotics for Klebsiella pneumonia osteomyelitis and was discharged uneventfully with optimal pain control and adequate respiratory effort.

Surgical Rib Fixation of Multiple Rib Fractures and Flail Chest: A Systematic Review and Meta-Analysis

BACKGROUND

Multiple rib fractures and flail chest are common in trauma patients and may result in significant morbidity and mortality. While rib fractures have historically been treated conservatively, there is increasing interest in the benefits of surgical fixation. However, strong evidence that supports surgical rib fixation and identifies the most appropriate patients for its application is currently sparse.

METHODS

A systematic review and meta-analysis following PRISMA guidelines was performed to identify all peer-reviewed papers that examined surgical compared to conservative management of rib fractures. We undertook a subgroup analysis to determine the specific effects of rib fracture type, age, the timing of fixation and study design on outcomes. The primary outcomes were the length of hospital and ICU stay, and secondary outcomes included mechanical ventilation time, rates of pneumonia, and mortality.

RESULTS

Our search identified 45 papers in the systematic review, and 40 were included in the meta-analysis. There was a statistical benefit of surgical fixation compared to conservative management of rib fractures for length of ICU stay, mechanical ventilation, mortality, pneumonia, and tracheostomy. The subgroup analysis identified surgical fixation was most favorable for patients with flail chest and those who underwent surgical fixation within 72 h. Patients over 60 y had a statistical benefit of conservative management on length of hospital stay and mechanical ventilation.

CONCLUSIONS

Surgical fixation of flail and multiple rib fractures is associated with a reduction in morbidity and mortality outcomes compared to conservative management. However, careful selection of patients is required for the appropriate application of surgical rib fixation.