Evaluation of efficacy and indications of surgical fixation for multiple rib fractures: a propensity-score matched analysis

• Published in: European journal of trauma and emergency surgery (Munich : 2007) 2017-08, Vol.43 (4), p.541-547
• Main Authors: Uchida, K., Nishimura, T., Takesada, H., Morioka, T., Hagawa, N., Yamamoto, T., Kaga, S., Terada, T., Shinyama, N., Yamamoto, H., Mizobata, Y.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Critical Care Medicine; Decision Support Techniques; Emergency Medicine; Female; Flail Chest - surgery; Fractures; Fractures, Multiple - diagnostic imaging; Fractures, Multiple - pathology; Fractures, Multiple - surgery; Humans; Injury Severity Score; Intensive; Intensive care; Japan; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgical Procedures - methods; Original Article; Predictive Value of Tests; Propensity Score; Retrospective Studies; Rib cage; Rib Fractures - diagnostic imaging; Rib Fractures - pathology; Rib Fractures - surgery; Sports Medicine; Surgery; Surgical Orthopedics; Traumatic Surgery; Young Adult
• ISSN: 1863-9933; 1863-9941
• DOI: 10.1007/s00068-016-0687-0

Purpose The purpose of this study was to assess the effects of recent surgical rib fixation and establish its indications not only for flail chest but also for multiple rib fractures. Methods Between 2007 and 2015, 187 patients were diagnosed as having multiple rib fractures in our institution. After the propensity score matching was performed, ten patients who had performed surgical rib fixation and ten patients who had treated with non-operative management were included. Categorical variables were analyzed with Fischer’s exact test and non-parametric numerical data were compared using the Mann–Whitney U test. Wilcoxon signed-rank test was performed for comparison of pre- and postoperative variables. All statistical data are presented as median (25–75 % interquartile range [IQR]) or number. Results The surgically treated patients extubated significantly earlier than non-operative management patients (5.5 [1–8] vs 9 [7–12] days: p  = 0.019). The duration of continuous intravenous narcotic agents infusion days (4.5 [3–6] vs 12 [9–14] days: p  = 0.002) and the duration of intensive care unit stay (6.5 [3–9] vs 12 [8–14] days: p  = 0.008) were also significantly shorter in surgically treated patients. Under the same ventilating conditions, the postoperative values of tidal volume and respiratory rate improved significantly compared to those values measured just before the surgery. The incidence of pneumonia as a complication was significantly higher in non-operative management group ( p  = 0.05). Conclusions From the viewpoints of early respiratory stabilization and intensive care unit disposition without any complications, surgical rib fixation is a sufficiently acceptable procedure not only for flail chest but also for repair of severe multiple rib fractures.