Rib fixation versus non-operative treatment for flail chest and multiple rib fractures after blunt thoracic trauma: a multicenter cohort study.

Content Provider	Europe PMC
Author	Beks, Reinier B. Reetz, David de Jong, Mirjam B. Groenwold, Rolf H. H. Hietbrink, Falco Edwards, Michael J. R. Leenen, Luke P. H. Houwert, Roderick Marijn Frölke, Jan Paul M.
Abstract	BackgroundOver the years, a trend has evolved towards operative treatment of flail chest although evidence is limited. Furthermore, little is known about operative treatment for patients with multiple rib fractures without a flail chest. The aim of this study was to compare rib fixation based on a clinical treatment algorithm with nonoperative treatment for both patients with a flail chest or multiple rib fractures.MethodsAll patients with ≥ 3 rib fractures admitted to one of the two contributing hospitals between January 2014 and January 2017 were retrospectively included in this multicenter cohort study. One hospital treated all patients nonoperatively and the other hospital treated patients with rib fixation according to a clinical treatment algorithm. Primary outcome measures were intensive care length of stay and hospital length of stay for patients with a flail chest and patients with multiple rib fractures, respectively. To control for potential confounding, propensity score matching was applied.ResultsA total of 332 patients were treated according to protocol and available for analysis. The mean age was 56 (SD 17) years old and 257 (77%) patients were male. The overall mean Injury Severity Score was 23 (SD 11) and the average number of rib fractures was 8 (SD 4). There were 92 patients with a flail chest, 37 (40%) had rib fixation and 55 (60%) had non-operative treatment. There were 240 patients with multiple rib fractures, 28 (12%) had rib fixation and 212 (88%) had non-operative treatment. For both patient groups, after propensity score matching, rib fixation was not associated with intensive care unit length of stay (for flail chest patients) nor with hospital length of stay (for multiple rib fracture patients), nor with the secondary outcome measures.ConclusionNo advantage could be demonstrated for operative fixation of rib fractures. Future studies are needed before rib fixation is embedded or abandoned in clinical practice.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC6689036&blobtype=pdf
ISSN	18639933
Journal	European Journal of Trauma and Emergency Surgery [Eur J Trauma Emerg Surg]
Volume Number	45
DOI	10.1007/s00068-018-1037-1
PubMed Central reference number	PMC6689036
Issue Number	4
PubMed reference number	30341561
e-ISSN	18639941
Language	English
Publisher	Springer Berlin Heidelberg
Publisher Date	2018-10-19
Publisher Place	Berlin/Heidelberg
Access Restriction	Open
Rights License	Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. © The Author(s) 2018
Subject Keyword	Rib fixation Non-operative treatment Flail chest Multiple rib fractures Rib fracture
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Emergency Medicine Surgery Critical Care and Intensive Care Medicine