![]() So we thought we could fix the ribs in the back, which would require just one incision and be less complicated than fixing them in the front, where you are dealing with the chest muscles inserting directly on the ribs," Dr. In our paper, it seemed that if we fixed one or two of the flails in the segment, the outcomes were equivalent. "He had flail ribs in both the front and back of his chest under the shoulder blade. The severely injured farm worker proved to be an exception. There was no difference in hospital length of stay, chest wall deformity, narcotic use or pulmonary function tests between the two groups, leading the authors to suggest that the additional surgery required for complete stabilization was unnecessary. Twenty-three had complete flail chest stabilization and 47 underwent partial stabilization. Schiller was senior author of a study published in 2016 in World Journal of Surgery that looked at 43 patients who underwent rib fracture stabilization procedures between 20. "He had declining X-ray lung volumes, so we knew we had to fix his ribs."īut which ribs? One nagging question is whether all the ribs in a flail should be fixed. "He was breathing on his own but was in so much pain, he wasn't moving much air into his chest," Dr. Among other serious injuries, he had a flail chest with four or five ribs in each flail segment. In 2016, a critically injured, 60-year-old farm worker presented to the emergency department at Mayo Clinic's campus in Minnesota. Sometimes we try to operate the day a patient is admitted," Dr. The rule of thumb for rib fracture stabilization is to operate within seven days of the injury because the risk of infection is lower and pain is markedly improved compared to repair delayed beyond seven days. "If the plates become infected, we have to remove them, leading to multiple operations. Then, once we go in, we realize that these simple fractures have more mobility than we thought."ĭespite this, the tendency is to manage rib fractures nonoperatively, mainly because of the risk of infection. We think some fractures may just appear to be simple because the patient is lying flat during imaging and not moving. We've learned that even people with nondisplaced fractures that don't seem bad on CT scans can actually have very unstable fractures. "Initially, we focused only on flail chest, but now we offer surgery to people with simple, non-flail rib fractures if their vital capacity is less than 1500 on serial exams and their chest X-ray lung volumes are decreasing. "As we've gained experience, we've learned which ribs should be fixed, and it's about 1 in 10," Dr. ![]() Still, only a small minority of patients with serious rib fractures are offered surgical stabilization. "We use nerve blocks and epidural anesthetics, which can provide temporary pain relief, but rib pain lasts for weeks, and none of the nonsurgical options are ideal for managing it." "The more unstable the fractures, the more it hurts and the more difficult for patients to breathe and maintain adequate pulmonary hygiene," he says. Long-term pain management is another benefit. An older adult on a breathing tube with pneumonia may not survive." "The risk of dying of rib fractures increases twofold at age 55, fivefold at 65 and sevenfold at 75. ![]() Rib fracture fixation benefitsĭecreased risk of pneumonia is one of the main reasons for surgical rib stabilization, especially in older patients, Dr. The review was published in the Journal of the American College of Surgeons. Other research, including a 2013 retrospective meta-analysis, found that rib fracture stabilization resulted in better outcomes overall, including decreased ventilator and ICU days and decreased rates of tracheostomy and pneumonia. Schiller and colleagues published a study in the European Journal of Trauma and Emergency Surgery showing that the procedure significantly improved forced vital capacity in patients with flail chest. Mayo Clinic began practicing rib fracture stabilization for adult patients 2009. Surgical rib fracture stabilization with titanium plates and screws
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