Surgical Management of Rib Fractures: Strategies and Literature Review.
OBJECTIVE
Rib fractures can cause significant problems in trauma patients, often resulting in pain and difficulty with respiration. To prevent pulmonary complications and decrease the morbidity and mortality rates of patients with rib fractures, currently there is a trend to provide surgical management of patients with flail chest. However, the indications for rib fracture fixation require further specification.


METHODS
Past and current strategies are described according to a review of the medical literature. A systematic review was performed including current indications for rib fracture fixation. MEDLINE (2000-2013) was searched, as well as Embase (2000-2013) and Cochrane Databases, using the keywords rib, fracture, fixation, plate, repair, and surgery.


RESULTS
Three retrospective studies were found that described different techniques for rib fracture fixation. The results demonstrated a reduced number of ventilation days, decreased long-term morbidity and pain, and satisfactory rehabilitation after surgical treatment. In addition to flail chest, age, Injury Severity Score, and the number of rib fractures were important predictive factors for morbidity and mortality.


CONCLUSIONS
Surgical rib fracture fixation might be indicated in a broader range of cases than is currently performed. Prospective randomized trials are needed for further confirmation.
Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
M B
MB
de Jong
Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
M C
MC
Kokke
Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
F
F
Hietbrink
Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands l.p.h.leenen@umcutrecht.nl.
L P H
LP
Leenen
Rib fracture; fixation; indications; surgical management