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Surgical management of severe rib fractures

Babak Sarani, MD, FACS, FCCM
Section Editors
Eileen M Bulger, MD, FACS
Joseph S Friedberg, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Multiple rib fractures are the consequence of significant forces impacting the chest wall and are most commonly due to blunt injuries (eg, motor vehicle crash, falls, assault), but penetrating injuries (eg, gunshot) can also fracture ribs. Conservative treatment includes pain control and aggressive supportive pulmonary care primarily aimed at avoiding the need for intubation, which is associated with increased rates of pneumonia and death. For patients who continue to have acute pain and are experiencing worsening pulmonary function in spite of optimal management (eg, flail chest) or those with rib fractures that do not heal (nonunion) and are causing persistent pain and functional impairment, surgical rib stabilization (also known as osteosynthesis) may be needed.

The indications, preparation, technique for rib fracture stabilization, and outcomes are reviewed here. Initial management of traumatic rib fractures is reviewed elsewhere. (See "Initial evaluation and management of blunt thoracic trauma in adults" and "Inpatient management of traumatic rib fractures".)


Generally accepted indications for operative rib fixation include the presence of [1,2]:

Painful, movable ribs refractory to pain management strategies resulting in impending or actual respiratory failure. (See "Inpatient management of traumatic rib fractures", section on 'Pain control'.)

Significant chest wall deformity.

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Literature review current through: Nov 2017. | This topic last updated: May 30, 2017.
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