I. Puente1,2,4, E. Picard1, J. Wycech2, G. DiPasquale2,3, R. Weisz1,2, A. Fokin2 4Broward Health Medical Center,Trauma,Fort Lauderdale, FL, USA 1Florida Atlantic University,College Of Medicine,Boca Raton, FL, USA 2Delray Medical Center,Trauma,Delray Beach, FL, USA 3Health Care District Palm Beach County,Trauma,Palm Springs, FL, USA
Introduction: Surgical fixation of rib fractures (SSRF) has expanded in use as a rival to conservative treatment. Disagreement remains regarding plating in patients with pulmonary contusion or without flail chest. The goal was to determine guidelines for surgical treatment.
Methods: In this IRB approved retrospective-cohort study, 48 patients underwent SSRF between 1/1/2011 and 6/1/2017 at a Level 1 trauma center. This group was matched to 50 nonoperative (NO) controls based on age, mechanism of injury, number of ribs fractured (RFX) and occurrence of flail chest. Incidence of pulmonary contusion and timing to rib plating were recorded. The hospital length of stay (HLOS), ICU LOS, and duration of mechanical ventilation (DMV) were then compared.
Results: SSRF (n=48) and NO (n=50) groups were similar in age (mean 58 y.o. in both), ISS (SSRF:20.0 vs NO:23.5, p=0.2), and RFX (6.7 in both, p=0.9). SSRF was performed 1-18 days of admission. SSFR within 18 days had significantly longer HLOS (SSRF:14.5 vs NO:9.2,p=0.007) and ICU LOS (SSRF:8.7 vs NO:4.2,p=0.001). If plating was done within 3 days, there was no longer a significant increase in HLOS (SSRF:12.4 vs NO:10.9,p=0.7) or ICU LOS (SSRF:7.2 vs NO:3.9,p=0.07). Patients without flail chest plated within 18 days (n=27) had increased HLOS (SSRF:14.7 vs NO:6.5,p<0.001) and increased ICU LOS (SSRF:8.9 vs NO:2.8,p=0.001) compared to NO controls (n=32). Within 3 days to plating, both HLOS (SSRF:12.3 vs NO:6.4,p=0.02) and ICU LOS (SSRF:7.4 vs NO:2.3,p=0.05) remained longer for SSRF patients (n=13) without flail chest compared to their controls (n=14). Patients with flail chest plated within 18 days (n=21) had similar HLOS (SSRF:14.2 vs NO:13.9,p=0.9) and ICU LOS (SSRF:8.3 vs NO:6.1,p=0.2) compared to their controls (n=18). Within 3 days to rib plating, HLOS and ICU LOS remained consistent for SSRF patients (n=10) compared to their controls (n=9). Patients without pulmonary contusion plated within 18 days (n=21), had similar HLOS (SSRF:13.6 vs NO:8.9,p=0.13), but significantly longer ICU LOS (SSRF:8.9 vs NO:2.7,p<0.001) compared to their NO controls (n=34). Within 3 days to plating, HLOS remained similar and ICU LOS longer for SSRF patients (n=10) compared to their controls (n=15). Patients with pulmonary contusion plated within 18 days (n=27) had significantly longer HLOS (SSRF:15.2 vs NO:9.8,p=0.03) but similar ICU LOS (SSRF:8.5 vs NO:6.8,p=0.50) compared to their NO controls (n=16). Within 3 days to plating, HLOS became similar (SSRF:12.2 vs NO:12.7,p=0.5) and ICU LOS remained similar for SSRF patients (n=13) compared to their controls (n=8). Differences in DMV were insignificant in all analyzed cases.
Conclusion: Plated patients had increased HLOS and ICU LOS. These differences were nullified when patients had flail chest, or had pulmonary contusion (if surgery was done within 3 days). Possible advantages of rib plating, including pain reduction and return to work, may be more obvious in long term follow-up.