Rib Fixation has no great edge in non-flail, non-ventilator dependent rib fractures

Rib fixation for non-flail, non-ventilator-dependent rib fractures has shown no improvements in pain or quality of life at 3 and 6 months as per a study that was published in 'The Journal of Trauma and Acute Care Surgery.' 

Rib fractures are common and can cause significant pain and disability in patients. The level 1 evidence for rib fixation in non–ventilator-dependent patients with chest wall injuries is minimal. So, researchers conducted a study to assess pain and quality of life (QoL) outcomes in patients with multiple painful displaced fractured ribs with and without operative fixation based on the hypothesis that surgical stabilization of rib fractures would reduce pain and improve QoL in 6 months. Hence a prospective multicenter randomized controlled trial was done comparing rib fixation to nonoperative management of nonventilated patients who have at least three consecutive rib fractures and have ongoing pain. The pain was assessed using the McGill pain questionnaire and Quality of life was assessed using Short Form 12 at 3- and 6 months post-injury. Patients were enrolled by the surgeons based on clinical equipoise. Patients who needed surgical fixation or who were too well to be randomized to rib fixation were not enrolled. 

Results: 

• A total of 124 patients were enrolled at four sites between 2017 and 2020.
• Sixty-one patients were randomized to operative management and 63 to nonoperative management.
• No differences were seen in the primary endpoint of the Pain Rating Index at 3 months or in the QoL measures.
• Return-to-work rates improved between 3 and 6 months, favoring the operative group.

Thus, the researchers found from the study that no improvements in pain or QoL at 3 and 6 months was seen in patients undergoing rib fixation for nonflail, non–ventilator-dependent rib fractures. 

To read the full article, click here: 10.1097/TA.0000000000003549 

Marasco SF, Balogh ZJ, Wullschleger ME, et al. Rib fixation in non-ventilator dependent chest wall injuries. Journal of Trauma and Acute Care Surgery. 2022; Publish Ahead of Print.