Surgical management of severe rib fractures
- Babak Sarani, MD, FACS, FCCM
Babak Sarani, MD, FACS, FCCM
- Associate Professor of Surgery
- Director, Center for Trauma and Critical Care
- George Washington University
- Section Editors
- Eileen M Bulger, MD, FACS
Eileen M Bulger, MD, FACS
- Section Editor — Trauma Surgery
- Professor of Surgery
- University of Washington
- Joseph S Friedberg, MD
Joseph S Friedberg, MD
- Section Editor — Thoracic Surgery
- Charles Reid Edwards Professor of Surgery
- University of Maryland
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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- EFFICACY OF RIB STABILIZATION
- Acute indications
- Chronic indications (nonunion/malunion)
- RIB FRACTURE STABILIZATION
- Timing of surgery
- Positioning and incisions
- Number of fractures to repair
- Plating types and techniques
- Need for thoracostomy
- PERIOPERATIVE CARE
- ADJUNCTIVE TECHNIQUES
- Iliac bone graft
- Demineralized bone matrix
- Experimental techniques
- SURGICAL COMPLICATIONS
- SUMMARY AND RECOMMENDATIONS