Surgical treatment of rib fractures more than one month after injury: a single-center experience

Abstract

Background: In recent years, surgical stabilization of rib fractures (SSRF) has gained widespread acceptance, with a prevailing consensus that the procedure should be performed as promptly as possible. However, it remains uncertain whether patients with rib fractures sustained for more than one month experience significant benefits from undergoing SSRF. This study primarily investigates the effectiveness and safety of SSRF in patients who have suffered rib fractures for over one month.

Methods: A retrospective analysis was performed on the clinical data of patients with rib fractures who were hospitalized between January 2017 and March 2023, specifically those who had sustained injuries for more than one month. All patients included in this study underwent SSRF. The analysis primarily focused on evaluating improvements in chest wall deformity, alleviation of chronic chest pain, and the incidence of postoperative complications following SSRF.

Results: This cohort consisted of 22 cases, among which 16 patients underwent SSRF within 1-3 months following their injuries, while the remaining 6 patients had SSRF performed after a period exceeding 3 months. In the early intervention group (1-3 months), comprising 16 patients, 12 (75%) presented with chest wall deformities, all of which demonstrated significant improvement postoperatively. The average preoperative pain score was recorded at 7.31 ± 0.68, in contrast to a postoperative score of 1.25 ± 0.43 (p < 0.05). Post-surgical complications included one case of chest wall numbness and another reporting a foreign body sensation in the chest wall. In the group consisting of 6 patients who underwent surgery more than 3 months post-injury, all demonstrated significant improvement in chest wall deformities following SSRF. The average preoperative pain score for this group was recorded at 5.17 ± 1.46, while the postoperative score indicated a notable reduction to 1.33 ± 0.47 (p < 0.05).

Conclusions: For patients with rib fractures who have not undergone SSRF within one month and continue to experience significant pain and/or chest wall deformities, it is recommended to consider a minimally invasive SSRF procedure via a small incision. This approach can improve the correction of chest wall deformity, alleviate chronic chest pain, and is associated with minimal postoperative complications.

Keywords: Postoperative complications; Rib fracture; Surgical outcomes; Surgical stabilization of the rib fractures (SSRF).

Fig. 1

Preoperative CT showed multiple rib fractures on the right side, with fracture ends separated. The soft tissue embedded in the fracture ends was removed, and the fracture ends were closed (arrow)