Evaluation of efficacy and indications of surgical fixation for multiple rib fractures: a propensity-score matched analysis.
OBJECTIVE
The purpose of this study was to assess the effects of recent surgical rib fixation and establish its indications not only for flail chest but also for multiple rib fractures.


METHODS
Between 2007 and 2015, 187 patients were diagnosed as having multiple rib fractures in our institution. After the propensity score matching was performed, ten patients who had performed surgical rib fixation and ten patients who had treated with non-operative management were included. Categorical variables were analyzed with Fischer's exact test and non-parametric numerical data were compared using the Mann-Whitney U test. Wilcoxon signed-rank test was performed for comparison of pre- and postoperative variables. All statistical data are presented as median (25-75 % interquartile range [IQR]) or number.


RESULTS
The surgically treated patients extubated significantly earlier than non-operative management patients (5.5 [1-8] vs 9 [7-12] days: p = 0.019). The duration of continuous intravenous narcotic agents infusion days (4.5 [3-6] vs 12 [9-14] days: p = 0.002) and the duration of intensive care unit stay (6.5 [3-9] vs 12 [8-14] days: p = 0.008) were also significantly shorter in surgically treated patients. Under the same ventilating conditions, the postoperative values of tidal volume and respiratory rate improved significantly compared to those values measured just before the surgery. The incidence of pneumonia as a complication was significantly higher in non-operative management group (p = 0.05).


CONCLUSIONS
From the viewpoints of early respiratory stabilization and intensive care unit disposition without any complications, surgical rib fixation is a sufficiently acceptable procedure not only for flail chest but also for repair of severe multiple rib fractures.
Department of Traumatology and Critical Care Medicine, Osaka City University, Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka City, Osaka, Japan. cvs.uchida@gmail.com.
K
K
Uchida
Department of Traumatology and Critical Care Medicine, Osaka City University, Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka City, Osaka, Japan.
T
T
Nishimura
Department of Traumatology and Critical Care Medicine, Osaka City University, Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka City, Osaka, Japan.
H
H
Takesada
Department of Traumatology and Critical Care Medicine, Osaka City University, Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka City, Osaka, Japan.
T
T
Morioka
Department of Traumatology and Critical Care Medicine, Osaka City University, Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka City, Osaka, Japan.
N
N
Hagawa
Department of Traumatology and Critical Care Medicine, Osaka City University, Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka City, Osaka, Japan.
T
T
Yamamoto
Department of Traumatology and Critical Care Medicine, Osaka City University, Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka City, Osaka, Japan.
S
S
Kaga
Department of Traumatology and Critical Care Medicine, Osaka City University, Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka City, Osaka, Japan.
T
T
Terada
Department of Traumatology and Critical Care Medicine, Osaka City University, Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka City, Osaka, Japan.
N
N
Shinyama
Department of Traumatology and Critical Care Medicine, Osaka City University, Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka City, Osaka, Japan.
H
H
Yamamoto
Department of Traumatology and Critical Care Medicine, Osaka City University, Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka City, Osaka, Japan.
Y
Y
Mizobata
D000293:Adolescent; D000328:Adult; D000368:Aged; D003661:Decision Support Techniques; D005260:Female; D005409:Flail Chest / Q000601:surgery; D000069076:Fractures, Multiple / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D007564:Japan; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011237:Predictive Value of Tests; D057216:Propensity Score; D012189:Retrospective Studies; D012253:Rib Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
Flail chest; Multiple rib fractures; Non-operative management; Operative result; Surgical rib fixation