title: Outcomes after operative management of symptomatic rib nonunion.
abstract: OBJECTIVE
  To report the outcomes of rib reconstruction after painful nonunion.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  Between November 2007 and May 2013, 10 patients who presented with 16 rib nonunions and disabling pain were treated with reconstruction of their nonunited rib fractures.
  
  
  METHODS
  Rib nonunion reconstruction predominately with iliac crest bone graft and a tension band plate with a locked precontoured plating system for ribs.
  
  
  METHODS
  Demographic data, mechanism of injury, and number of rib nonunions were recorded. Operative procedure, length of follow-up, complications, Short Form Survey 36, and a patient questionnaire were also captured and documented.
  
  
  RESULTS
  Eight of the 10 patients sustained their original fractures from a fall. Outcomes were available for the 10 patients at a mean follow-up of up of 18.6 months (range, 3-46 months). All 16 ribs went on to union with a mean time from reconstruction to union of 14.7 weeks (range, 12-24 weeks). At final follow-up, the mean mental and physical component Short Form Survey 36 scores were 54.4 and 43.5, respectively. Eight of the 10 patients were able to return to work and/or previous activities without limitations. Complications included 1 wound infection that resolved after irrigation and debridement with adjunctive antibiotics. One symptomatic implant was removed.
  
  
  CONCLUSIONS
  Ten patients with 16 symptomatic rib nonunions were reconstructed using autologous bone graft and implant/mesh fixation manifesting in successful union with improved patient function and a low rate of complications.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedic Surgery, Regions Hospital, University of Minnesota, Saint Paul, MN; and †Department of Orthopaedic Surgery, Saint Louis University Hospital, St. Louis, MO.
authors.forename: Erich M
authors.initials: EM
authors.lastname: Gauger
authors.forename: Brian W
authors.initials: BW
authors.lastname: Hill
authors.forename: Paul M
authors.initials: PM
authors.lastname: Lafferty
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cole
mesh_terms: D000328:Adult; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D003131:Combined Modality Therapy / Q000295:instrumentation / Q000379:methods; D005260:Female; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D012253:Rib Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome