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. 2023 Feb;143(2):887-893.
doi: 10.1007/s00402-022-04362-z. Epub 2022 Feb 8.

Rib fractures in the elderly population: a systematic review

Ruben J Hoepelman  1   2 , Frank J P Beeres  2   3 , Marilyn Heng  4 , Matthias Knobe  2 , Björn-Christian Link  2 , Fabrizio Minervini  2 , Reto Babst  2   3 , Roderick M Houwert  1 , Bryan J M van de Wall  5   6
Affiliations

Rib fractures in the elderly population: a systematic review

Ruben J Hoepelman et al. Arch Orthop Trauma Surg. 2023 Feb.

Abstract

Background: Multiple rib fractures are associated with significant morbidity and mortality, especially in elderly patients. There is growing interest in surgical stabilization in this subgroup of patients. This systematic review compares conservative treatment to surgical fixation in elderly patients (older than 60 years) with multiple rib fractures. The primary outcome is mortality. Secondary outcomes include hospital and intensive care length of stay (HLOS and ILOS), duration of mechanical ventilation (DMV) and pneumonia rates.

Methods: Multiple databases were searched for comparative studies reporting on conservative versus operative treatment for rib fractures in patients older than 60 years. Both observational studies and randomised clinical trials were considered.

Results: Five observational studies (n = 2583) were included. Mortality was lower in operatively treated patients compared to conservative treatment (4% vs. 8%). Pneumonia rate and DMV were similar (5/6% and 5.8/6.5 days) for either treatment modality. Overall ILOS and HLOS of stay were longer in operatively treated patients (6.5 ILOS and 12.7 HLOS vs. 2.7 ILOS and 6.5 ILOS). There were only minimal reports on perioperative complications. Notably, the median number of rib fractures (8.4 vs. 5) and the percentage of flail chest were higher in operatively treated patients (47% vs. 39%).

Conclusion: It remains unknown to what extent conservative and operative treatment contribute individually to reducing morbidity and mortality in the elderly with multiple rib fractures. To date, the quality of evidence is rather low, thus well-performed comparative observational studies or randomised controlled trials considering all confounders are needed to determine whether operative treatment can improve a patient's outcome.

Keywords: Conservative treatment; Rib fixation; Rib fractures; Systematic review.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram representing the search and screening process of articles comparing nonoperative to operative treatment in elderly. From Page et al. [10]
See this image and copyright information in PMC

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