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Indications for Rib Fixation

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Rib Fracture Management

Abstract

There are no clear, absolute, and universally accepted indications or contraindications for operative rib fixation. Furthermore, although the majority of experts believe patients benefit most from early operative fixation, there is no consensus agreement regarding optimal timing of surgery. The most common and well-accepted indication for operative rib fixation is the presence of a flail chest segment in a patient on mechanical ventilation with no underlying pulmonary contusion. This indication is in concordance with the clinical practice guidelines issued by the Eastern Association for the Surgery of Trauma. Additional relative indications supported by the literature and recommended by experts in the field include severe chest wall deformity, symptomatic rib fracture nonunion, acute pulmonary herniation, failure to wean from mechanical ventilation or poor pulmonary mechanics in a patient with severe chest wall trauma, need for acute or chronic pain/symptom control, and thoracotomy for another reason. Surgeons should take into consideration possible contraindications for operative repair including the location of rib fractures and presence of either pulmonary contusion or traumatic brain injury.

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Author information

Authors and Affiliations

  1. Department of Surgery, UW Hospital and Clinics, University of Wisconsin, Madison, WI, USA

    Tiffany Zens

  2. Division of Trauma and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Krista Haines & Suresh Agarwal

Authors
  1. Tiffany Zens
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  2. Krista Haines
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  3. Suresh Agarwal
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Correspondence to Suresh Agarwal .

Editor information

Editors and Affiliations

  1. Medical College of Wisconsin, Froedtert Trauma Center, Milwaukee, WI, USA

    Marc de Moya

  2. Saint Alphonsus Regional Medical Center, Boise, ID, USA

    John Mayberry

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Zens, T., Haines, K., Agarwal, S. (2018). Indications for Rib Fixation. In: de Moya, M., Mayberry, J. (eds) Rib Fracture Management . Springer, Cham. https://doi.org/10.1007/978-3-319-91644-6_8

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  • DOI: https://doi.org/10.1007/978-3-319-91644-6_8

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