C. L. Mullens1,2, M. J. Seamon1, A. Shiroff1, J. Cannon1, L. Kaplan1, J. Pascual1, D. Holena1, N. D. Martin1 1Hospital Of The University Of Pennsylvania,Department Of Surgery; Division Of Traumatology, Surgical Critical Care, And Emergency Surgery,Philadelphia, PA, USA 2West Virginia University School of Medicine,Morgantown, WV, USA
Introduction:
Rib fractures are a common consequence of traumatic injury and can result in significant debilitation. Rib fixation offers fracture stabilization, resulting in improved outcomes and decreased pulmonary complications, especially in high-risk groups such as those with flail segments. However, commercial rib fixation has only recently become clinically prevalent and we hypothesize that significant opportunity exists in the broader population to offer this clinical advantage.
Methods:
The Pennsylvania Trauma System Foundation database was queried for all rib fracture patients occurring statewide during calendar years 2016 & 2017. Demographics including Abbreviated Injury Scores (AIS) for all body areas, the presence of flail, and the occurrence of rib fixation was abstracted. Outcomes were compared between the fixation group and all rib fracture patients using t-test and chi-square where appropriate. Each repaired patient was used to identify matched peers in the unrepaired, multiply-fractured cohort using age, sex, ISS, and AIS. De-identified treating trauma center was used to elicit center-level disparities.
Results:
During the study period, there were 16,302 patients with rib fractures of which 12,910 had multiple rib fractures and 135 had flail segments. 57 patients underwent rib fixation, 10 of which had a flail. As compared to the non-operative, multi-rib fractured cohort, those who underwent rib fixation were younger (52.5 vs 61.5, p=0.0009) but similar in gender (68% vs 62% male, p=0.373) and race (80% vs 86% white, p=0.239). The rib fixation group had higher Injury Severity Scores (19.4 vs 15.4 p=0.0011). Cumulative non-thorax AIS score means were similar between groups as well (0.58 vs 0.64, p=0.76). 4,430 matched peers were identified in the multiply-fractured, unrepaired group as compared to the rib fixation group. 18 of 42 accredited trauma centers performed rib fixation during the study period. 4,796 (37.1%) of multiple rib fracture patients were cared for at centers not performing rib fixation.
Conclusion:
Rib fixation is underutilized as compared to the contemporary population of those who underwent repair. Center-level disparities exist as well, suggesting that further penetrance of this treatment into clinical practice is warranted. Additionally, patient-level disparities suggest further research is needed to illicit better defined indications for operative fixation.