Surgical rib fixation as an alternative method of treatment for multiple rib fractures : an audit of results compared with traditional medical management

Abstract

BACKGROUND : Rib fractures are a common cause of morbidity and chronic pain, delaying return to normal activities. Reports suggest that surgical fixation improves acute and long-term outcomes. METHOD : A single centre retrospective review of multiple rib fractures, comparing the outcomes of cases managed using surgical fixation with cases managed only with best medical therapy (BMT) over 2 years. RESULTS : Thirty-five patients with rib fractures were admitted over the study period. The most common causes of rib fractures were motorcycle crashes (34.2%) and falls (31.4%). Fourteen patients had surgery. There were no differences between the two groups regarding the number of fractured ribs, injury severity score (ISS), ICU or hospital length of stay. The median numeric pain visual analogue scale (VAS) on admission was eight points for non-ventilated patients. In the surgical group the median VAS significantly fell to a median of 2 points in the first 24 hours after surgery (p = 0.04). Only two out of 25 major complications were directly attributable to the surgery for rib fixation. Patients managed without surgery needed significantly longer time to return to normal activities compared to those who had surgery (median 7 weeks versus 3 weeks, p = 0.03). CONCLUSIONS : Our preliminary results suggest that rib fixation should be considered a treatment alternative in patients with multiple rib fractures.