The Journal of Cardiothoracic Trauma

REVIEW ARTICLE
Year
: 2022  |  Volume : 7  |  Issue : 1  |  Page : 2--3

Management of rib fractures following blunt chest wall trauma: Are we there yet?


Bhavik Patel 
 Department of Surgery, Gold Coast University Hospital, Southport; Department of Surgery, St. Andrew's War Memorial Hospital, Queensland, Australia

Correspondence Address:
Bhavik Patel
Gold Coast University Hospital, 1, Hospital Boulevard, Southport, Queensland - 4030
Australia




How to cite this article:
Patel B. Management of rib fractures following blunt chest wall trauma: Are we there yet?.J Cardiothorac Trauma 2022;7:2-3


How to cite this URL:
Patel B. Management of rib fractures following blunt chest wall trauma: Are we there yet?. J Cardiothorac Trauma [serial online] 2022 [cited 2023 Jan 28 ];7:2-3
Available from: https://www.jctt.org/text.asp?2022/7/1/2/366397


Full Text



Trauma care providers are aware of the morbidities associated with blunt chest wall injuries. The presence of three or more rib fractures has been associated with increased mortality and duration of care in the intensive care units and hospitals.[1] Among the elderly, rib fractures have been associated with a 31% rate of nosocomial pneumonia.[2]

Literature suggests marked improvement in the management of this condition by the introduction of multi-disciplinary pathways which are specific to available local expertise.

Surgical stabilization of rib fractures (SSRFs) is an important step in this pathway. Patients on respiratory support in the Intensive Care Unit or the geriatric population with unstable chest wall mechanics are well served with this procedure.[3],[4]

However, there is still no clear consensus on outcome of surgery on the nonventilated patient with unstable chest wall injury.[5],[6]

Despite increasing evidence especially in patients on respiratory support, there is significant variation in the management of patients presenting to trauma centers with unstable chest wall physiology. This could be secondary to multiple factors, including but not restricted to hesitancy from surgeons to carry out this procedure, anesthesiologist being unfamiliar with the procedure, theater availability, hardware availability, patient reluctance, and absence of postoperative in and outpatient follow-up pathways.

Several organizations/societies with special interest in chest wall injury management highlight poor outcomes in this injury pattern if not managed in a multi-disciplinary pathway i.e., timely access to locoregional blocks, physiotherapy, and optimization of comorbidities.

However, are we as trauma providers doing enough to support these centers to prevent disparity of care in the management of patients with blunt chest wall injuries? Should there be more education/involvement for the regional trauma surgeon? Should hardware be cheaper and easily available?

Another area of concern is the long-term outcome of SSRF. Despite rapid uptake worldwide, there is a dearth in the literature with regard to >10 years follow-up with the outcomes for patients undergoing this procedure.

Even though there are societies and organizations in the management of blunt chest wall injury, I do not think we are there yet to prevent disparity of care in this condition and maybe we should encourage trauma systems to develop chest wall injury pathways to standardize patient management.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma 1994;37:975-9.
2Lee RB, Bass SM, Morris JA Jr., MacKenzie EJ. Three or more rib fractures as an indicator for transfer to a level I trauma center: A population-based study. J Trauma 1990;30:689-94.
3Cooper E, Wake E, Cho C, Wullschleger M, Patel B. Outcomes of rib fractures in the geriatric population: A 5-year retrospective, single-institution, Australian study. ANZ J Surg 2021;91:1886-92.
4Ali-Osman F, Mangram A, Sucher J, Shirah G, Johnson V, Moeser P, et al. Geriatric (G60) trauma patients with severe rib fractures: Is muscle sparing minimally invasive thoracotomy rib fixation safe and does it improve post-operative pulmonary function? Am J Surg 2018;216:46-51.
5Marasco SF, Balogh ZJ, Wullschleger ME, Hsu J, Patel B, Fitzgerald M, et al. Rib fixation in non-ventilator-dependent chest wall injuries: A prospective randomized trial. J Trauma Acute Care Surg 2022;92:1047-53.
6Pieracci FM, Leasia K, Bauman Z, Eriksson EA, Lottenberg L, Majercik S, et al. A multicenter, prospective, controlled clinical trial of surgical stabilization of rib fractures in patients with severe, nonflail fracture patterns (chest wall injury society NONFLAIL). J Trauma Acute Care Surg 2020;88:249-57.