A clinical study on the surgical treatment of simple multiple rib fractures in older adult patients

Abstract

Background: The treatment of simple rib fractures in older adults can be divided into surgical treatment and nonsurgical treatment, with indications for surgery presently being unclear. This study was conducted to determine whether older adult individuals with simple multiple rib fractures can benefit from surgical treatment.

Methods: A single-center, retrospective study was conducted. All 880 registry-identified patients aged ≥60 years who were admitted to Beijing Jishuitan Hospital with blunt rib fractures between 2013 to 2020 were included. They were divided into 2 groups according to whether internal fixation was performed. After screening of inclusion and exclusion criteria and propensity score matching, there were 226 patients, 113 of whom were placed in the operation group and 113 in the nonoperation group. The demographic characteristics, underlying diseases, number of rib fractures, hospital stay, intensive care unit (ICU) hospital stay, mechanical ventilation duration, fracture comorbidities on admission, pain index, and fracture healing condition were analyzed using chi-squared test and independent samples t test.

Results: The pain score and fracture healing time were significantly improved in the operation group (P<0.05), while the duration of painkiller use was significantly shorter in the operation group (P=0.009). However, there was no significant differences in mortality, the incidence of bone nonunion, length of stay in the ICU, or duration of mechanical ventilation between the 2 groups.

Conclusions: For patients in the clinical study, internal fixation surgery could reduce fracture healing time and minimize the use of painkillers. Surgical treatment was determined to be safe, as it did not increase the mortality of the older adult patients. For older patients with simple rib fractures who have no contraindications to surgery, internal fixation surgery is recommended.

Keywords: Geriatrics; internal fixation; simple multiple rib fractures; surgical treatment.

Figure 1

Internal fixation of a multiple rib fracture. A 75-year-old male with multiple traumas including sternal fractures, fractures of the right ribs 1–3 and 5–11 and left ribs 1 and 6–9, cartilage fractures of the left ribs 1–5, bilateral pleural effusions, and bilateral lung contusions. (A) CT 3D reconstruction prior to surgery suggested fractures of the sternum and ribs. (B) Preoperative plain CT scan revealed transverse sternal fracture and subcutaneous emphysema. (C) Intraoperative image of internal fixation after placement. (D) Postoperative CT 3D reconstruction suggested that the sternal fracture and the fracture of the left ribs 3–5 were repositioned and that the internal fixation was well positioned. CT, computed tomography.

Figure 2

CT scan images of a patient with rib fracture. A 63-year-old female with multiple trauma, scaphoid fracture, fracture of the left ribs 2–4, contusion of the left lung, and pulmonary infection. (A) Preoperative CT 3D reconstruction suggested a left scaphoid fracture and fracture of ribs 2–4. (B) Postoperative CT 3D reconstruction suggested good repositioning of the left fractured ribs 2–4 and good position of the internal fixation. (C) Preoperative CT scan suggested left rib fractures, left scaphoid fracture, and left lung contusion. (D) Three months after operation, a CT axial plain scan showed that the fracture of the left rib had healed well and that there was continuous callus formation at the fracture. The cortical bone of the left scapula was discontinuous, and the fracture was not yet healed. CT, computed tomography.

Figure 3

The STROBE diagram for the study. CT, computed tomography; STROBE, The Strengthening the Reporting of Observational Studies in Epidemiology.

Figure 4

The number of patients and operations over the past 8 years.