title: Surgical stabilization of severe rib fractures decreases incidence of retained hemothorax and empyema.
abstract: BACKGROUND
  Retained hemothorax (RH) is relatively common after chest trauma and can lead to empyema. We hypothesized that patients who have surgical fixation of rib fractures (SSRF) have less RH and empyema than those who have medical management of rib fractures (MMRF).
  
  
  METHODS
  Admitted rib fracture patients from January 2009 to June 2013 were identified. A 2:1 propensity score model identified MMRF patients who were similar to SSRF. RH, and empyema and readmissions, were recorded. Variables were compared using Fisher exact test and Wilcoxon rank-sum tests.
  
  
  RESULTS
  One hundred thirty-seven SSRF and 274 MMRF were analyzed; 31 (7.5%) had RH requiring 35 interventions; 3 (2.2%) SSRF patients had RH compared with 28 (10.2%) MMRF (P = .003). Four (14.3%) MMRF subjects with RH developed empyema versus zero in the SSRF group (P = .008); 6 (19.3%) RH patients required readmission versus 14 (3.7%) in the non-RH group (P = .002).
  
  
  CONCLUSIONS
  Patients with rib fractures who have SSRF have less RH compared with similar MMRF patients. Although not a singular reason to perform SSRF, this clinical benefit should not be overlooked.
authors.affiliation: Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT, 84107, USA. Electronic address: sarah.majercik@imail.org.
authors.forename: Sarah
authors.initials: S
authors.lastname: Majercik
authors.affiliation: Surgical Services Clinical Program, Intermountain Medical Center, Murray, UT, USA.
authors.forename: Sathya
authors.initials: S
authors.lastname: Vijayakumar
authors.affiliation: Surgical Services Clinical Program, Intermountain Medical Center, Murray, UT, USA.
authors.forename: Griffin
authors.initials: G
authors.lastname: Olsen
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Wilson
authors.affiliation: Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT, 84107, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Gardner
authors.affiliation: Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT, 84107, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Granger
authors.affiliation: Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT, 84107, USA.
authors.forename: Don H
authors.initials: DH
authors.lastname: Van Boerum
authors.affiliation: Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT, 84107, USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: White
mesh_terms: D004653:Empyema / Q000000981:diagnostic imaging / Q000209:etiology* / Q000382:microbiology; D005260:Female; D006491:Hemothorax / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D013902:Radiography, Thoracic; D012042:Registries; D012253:Rib Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: Outcomes; Retained hemothorax; Rib fractures; Surgical stabilization of rib fractures; Thoracic trauma