The ideal methods for the management of rib fractures

Abstract

The clinical treatment choices for multiple rib fractures and flail chest are controversial. For example, among conservative treatment and surgical treatment, different studies have different conclusions and recommendations. Furthermore, early clinical research was mainly focused on the treatment of flail chest due to its severity. Nowadays, the treatment for multiple rib fractures patients without a flail chest is drawing an increased clinical interest. However, we are facing many challenges for the treatment of rib fractures, such as insufficient understanding of the available treatment options, lack of clinical research, lack of the internationally recognized clinical indication for the surgical stabilization of rib fractures (SSRF), and the constant controversies and debates in terms of treatment options, surgery timing, and surgical techniques. All these challenges make it difficult to select the most appropriated clinical decisions for the proper treatment of a rib fracture, resulting in a seriously hindered development of novel rib fractures treatment choices. The concepts and ideas for traditional rib fractures treatment are relatively old, and even have some misunderstandings or errors. With the emergence of more and more research, the understandings of the rib fractures treatment has gradually improved; for example, the benefits provided to patients under the open reductions and internal fixation of fractures treatment. In this article, we outlined the new concepts in rib fractures treatment, which mainly included four parts, damage control, pain management, fixation selection, and quality of life. We hope these concepts help practitioners better manage rib fracture patients.

Keywords: Rib fractures; flail chest; pain management; rib fractures management; surgical stabilization of rib fractures (SSRF).

Figure 1

Traditional incision is large and over-emphasize on the exposure, resulting in relatively large tissue damage (two figures were from two different cases).

Figure 2

Mininally invasive osteosynthesis. (A) Incision of muscle-sparing exposure of lateral and dorsal fracture series; (B) incision of subaxillary mini-thoracotomy exposure of lateral fracture series.

Figure 3

The application of MIPO helps to operate with a small incision, reducing the tissue damage. MIPO, minimally invasive plate osteosynthesis.

Figure 4

MIPO technique was applied to fix the 3–9 ribs fracture under the left scapula with an 8 cm incision. MIPO, minimally invasive plate osteosynthesis.