title: Surveyed opinion of American trauma, orthopedic, and thoracic surgeons on rib and sternal fracture repair.
abstract: BACKGROUND
  Rib and sternal fracture repair are controversial. The opinion of surgeons regarding those patients who would benefit from repair is unknown.
  
  
  METHODS
  Members of the Eastern Association for the Surgery of Trauma, the Orthopedic Trauma Association, and thoracic surgeons (THS) affiliated with teaching hospitals in the United States were recruited to complete an electronic survey regarding rib and sternal fracture repair.
  
  
  RESULTS
  Two hundred thirty-eight trauma surgeons (TRS), 97 orthopedic trauma surgeons (OTS), and 70 THS completed the survey. Eighty-two percent of TRS, 66% of OTS, and 71% of THS thought that rib fracture repair was indicated in selected patients. A greater proportion of surgeons thought that sternal fracture repair was indicated in selected patients (89% of TRS, 85% of OTS, and 95% of THS). Chest wall defect/pulmonary hernia (58%) and sternal fracture nonunion (>6 weeks) (68%) were the only two indications accepted by a majority of respondents. Twenty-six percent of surgeons reported that they had performed or assisted on a chest wall fracture repair, whereas 22% of surgeons were familiar with published randomized trials of the surgical repair of flail chest. Of surgeons who thought rib fracture or sternal fracture repair was rarely, if ever, indicated, 91% and 95%, respectively, specified that a randomized trial confirming efficacy would be necessary to change their negative opinion.
  
  
  CONCLUSIONS
  A majority of surveyed surgeons reported that rib and sternal fracture repair is indicated in selected patients; however, a much smaller proportion indicated that they had performed the procedures. The published literature on surgical repair is sparse and unfamiliar to most surgeons. Barriers to surgical repair of rib and sternal fracture include a lack of expertise among TRS, lack of research of optimal techniques, and a dearth of randomized trials.
authors.affiliation: Department of Surgery, Trauma/Critical Care Section, Oregon Health and Science University, Portland, Oregon 97239, USA. mayberrj@ohsu.edu
authors.forename: John C
authors.initials: JC
authors.lastname: Mayberry
authors.forename: L Bruce
authors.initials: LB
authors.lastname: Ham
authors.forename: Paul H
authors.initials: PH
authors.lastname: Schipper
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Ellis
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Mullins
mesh_terms: D001291:Attitude of Health Personnel; D001860:Bone Plates; D001863:Bone Screws; D001864:Bone Wires; D003625:Data Collection; D019317:Evidence-Based Medicine; D005409:Flail Chest / Q000601:surgery; D005592:Fracture Fixation; D005593:Fracture Fixation, Internal; D005594:Fracture Fixation, Intramedullary; D050723:Fractures, Bone / Q000601:surgery*; D005599:Fractures, Ununited / Q000601:surgery; D006801:Humans; D009985:Orthopedics; D016032:Randomized Controlled Trials as Topic; D012253:Rib Fractures / Q000601:surgery*; D013249:Sternum / Q000293:injuries*; D013903:Thoracic Surgery; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000601:surgery*