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Observational Study
. 2023 Feb;49(1):461-471.
doi: 10.1007/s00068-022-02093-9. Epub 2022 Aug 25.

Non-operative vs. operative treatment for multiple rib fractures after blunt thoracic trauma: a multicenter prospective cohort study

Ruben J Hoepelman  1 , Frank J P Beeres  2 , Reinier B Beks  3 , Arthur A R Sweet  3 , Frank F Ijpma  4 , Koen W W Lansink  5 , Bas van Wageningen  6 , Tjarda N Tromp  6 , Björn-Christian Link  2 , Nicole M van Veelen  2 , Jochem M Hoogendoorn  7 , Mirjam B de Jong  3 , Mark C P van Baal  3 , Luke P H Leenen  3 , Rolf H H Groenwold  8   9 , Roderick M Houwert  3
Affiliations
Observational Study

Non-operative vs. operative treatment for multiple rib fractures after blunt thoracic trauma: a multicenter prospective cohort study

Ruben J Hoepelman et al. Eur J Trauma Emerg Surg. 2023 Feb.

Abstract

Background: Patients with multiple rib fractures without a clinical flail chest are increasingly being treated with rib fixation; however, high-quality evidence to support this development is lacking.

Methods: We conducted a prospective multicenter observational study comparing rib fixation to non-operative treatment in all patients aged 18 years and older with computed tomography confirmed multiple rib fractures without a clinical flail chest. Three centers performed rib fixation as standard of care. For adequate comparison, the other three centers performed only non-operative treatment. As such clinical equipoise formed the basis for the comparison in this study. Patients were matched using propensity score matching.

Results: In total 927 patients with multiple rib fractures were included. In the three hospitals that performed rib fixation, 80 (14%) out of 591 patients underwent rib fixation. From the nonoperative centers, on average 71 patients were adequately matched to 71 rib fixation patients after propensity score matching. Rib fixation was associated with an increase in hospital length of stay (HLOS) of 4.9 days (95%CI 0.8-9.1, p = 0.02) and a decrease in quality of life (QoL) measured by the EQ5D questionnaire at 1 year of 0.1 (95% CI - 0.2-0.0, p = 0.035) compared to non-operative treatment. A subgroup analysis of patients who received operative care within 72 h showed a similar decrease in QoL. Up to 22 patients (28%) who underwent surgery experienced implant-related irritation.

Conclusions: We found no benefits and only detrimental effects associated with rib fixation. Based on these results, we do not recommend rib fixation as the standard of care for patients with multiple rib fractures.

Trial registration: Registered in the Netherlands Trial Register NTR6833 on 13/11/2017.

Keywords: Multiple rib fractures; Non-operative treatment; Rib fixation; Rib fracture.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Flow chart of inclusions per study site. RF rib fixation, NOM nonoperative management
See this image and copyright information in PMC

References

    1. Peek J, Ochen Y, Saillant N, Groenwold RHH, Leenen LPH, Uribe-Leitz T, et al. Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank. Trauma Surg Acute Care Open. 2020;5:e000441. doi: 10.1136/tsaco-2020-000441. - DOI - PMC - PubMed
    1. Peek J, Beks RB, Hietbrink F, de Jong MB, Heng M, Beeres FJP, et al. Epidemiology and outcome of rib fractures: a nationwide study in the Netherlands. Eur J Trauma Emerg Surg. 2020 doi: 10.1007/s00068-020-01412-2. - DOI - PMC - PubMed
    1. Kane ED, Jeremitsky E, Pieracci FM, Majercik S, Doben AR. Quantifying and exploring the recent national increase in surgical stabilization of rib fractures. J Trauma Acute Care Surg. 2017;83:1047–1052. doi: 10.1097/TA.0000000000001648. - DOI - PubMed
    1. Pieracci FM, Majercik S, Ali-Osman F, Ang D, Doben A, Edwards JG, et al. Consensus statement: surgical stabilization of rib fractures rib fracture colloquium clinical practice guidelines. Injury. 2017;48:307–321. doi: 10.1016/j.injury.2016.11.026. - DOI - PubMed
    1. Beks RB, Peek J, de Jong MB, Wessem KJP, Öner CF, Hietbrink F, et al. Fixation of flail chest or multiple rib fractures: current evidence and how to proceed. A systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2019;45:631–644. doi: 10.1007/s00068-018-1020-x. - DOI - PMC - PubMed

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