Surgical Stabilization of Rib Fractures: Indications and Technique

Abstract

Rib fractures are present in approximately 10% of patients and flail chest, defined as three or more ribs fractured at two points, is present in 3–5% of patients admitted to a trauma center (Dehghan et al., J Trauma Acute Care Surg 76(2):462–468, 2014; Ziegler and Agarwal, J Trauma 37(6):975–979, 1994). Six or more rib fractures and flail chest are strongly associated with respiratory failure, need for prolonged hospitalization, and death. The Eastern Association for the Surgery of Trauma (EAST) practice management guidelines for the treatment of flail chest support the use of surgical stabilization of rib fractures (SSRF) in patients who cannot be liberated from mechanical ventilation despite use of a multimodality pain regimen. In this group, SSRF has been shown to significantly reduce the need for and duration of mechanical ventilation, need for tracheostomy, risk of developing pneumonia, and death. As such, it is imperative that trauma surgeons be well versed in this technique.