Is fixation of a single end of flail segment rib fractures enough?
Background Segmental rib fractures in blunt thoracic trauma present with increased morbidity and mortality with an association of increased pulmonary insult and concomitant injuries. There is a paucity within the literature regarding the necessity of fixation of one or both segments of rib fractures...
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BMJ Publishing Group
2025-05-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/10/2/e001707.full |
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| author | Nicholas Pelz Anthony Perugini James Iandoli Daniel DeGenova Anthony Melaragno Mallory Faherty Benjamin C Taylor |
| author_facet | Nicholas Pelz Anthony Perugini James Iandoli Daniel DeGenova Anthony Melaragno Mallory Faherty Benjamin C Taylor |
| author_sort | Nicholas Pelz |
| collection | DOAJ |
| description | Background Segmental rib fractures in blunt thoracic trauma present with increased morbidity and mortality with an association of increased pulmonary insult and concomitant injuries. There is a paucity within the literature regarding the necessity of fixation of one or both segments of rib fractures in a flail chest. This study aimed to analyze surgical rib fixation and assess outcomes for non-fixed fractured rib ends in segmental rib fractures.Methods This is a retrospective review of 125 patients who underwent open reduction internal fixation of flail segmental rib fractures at our urban Level 1 trauma center. Initial plain films and CT were compared with follow-up plain film imaging at 3 months to assess radiographic outcomes, fracture healing, fixation failure, or residual deformity. Clinical outcomes such as length of intensive care unit (ICU) stay, length of ventilatory support, associated pneumonia, duration until chest tube removal, and need for additional rib surgery were analyzed.Results Fixation of a single end of segmental rib fractures and flail segments was associated with decreased incidence of fracture union at 3 months postoperatively (43/55 vs 65/70, respectively; p=0.018) but failed to show any difference in fracture collapse (50/55 vs 67/70, respectively; p=0.223). There were no differences between postoperative ICU length of stay (4.18±5.54 vs 4.62±4.48 days, respectively; p=0.690), postoperative ventilatory status (29/55 vs 38/70, respectively; p=0.840), duration of ventilatory support (3.52±4.69 vs 4.34±5.87, respectively; p=0.430), or associated pneumonia (7/55 vs 8/70, respectively; p=0.770).Conclusions These data support that fixation of both sides of flail segment rib fractures results in improved rib fracture union at 3 months postoperatively. However, fixation of both sides of flail segments does not appear to result in any difference in fracture collapse or clinical perioperative outcomes.Level of Evidence Therapeutic Level III |
| format | Article |
| id | doaj-art-8f27d748ab76475eba19d40b3a7ab22f |
| institution | OA Journals |
| issn | 2397-5776 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-8f27d748ab76475eba19d40b3a7ab22f2025-08-20T02:01:20ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762025-05-0110210.1136/tsaco-2024-001707Is fixation of a single end of flail segment rib fractures enough?Nicholas Pelz0Anthony Perugini1James Iandoli2Daniel DeGenova3Anthony Melaragno4Mallory Faherty5Benjamin C Taylor6Orthopedic Surgery, OhioHealth, Columbus, Ohio, USAOrthopedic Surgery, OhioHealth, Columbus, Ohio, USADepartment of Orthopedics, OhioHealth Doctor`s Hospital, Columbus, Ohio, USADepartment of Orthopedics, OhioHealth Doctor`s Hospital, Columbus, Ohio, USADepartment of Orthopedics, OhioHealth Doctor`s Hospital, Columbus, Ohio, USAOhioHealth Research Institute, OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USAOrthopedic Trauma and Reconstructive Surgeons, OhioHealth Grant Medical Center, Columbus, Ohio, USABackground Segmental rib fractures in blunt thoracic trauma present with increased morbidity and mortality with an association of increased pulmonary insult and concomitant injuries. There is a paucity within the literature regarding the necessity of fixation of one or both segments of rib fractures in a flail chest. This study aimed to analyze surgical rib fixation and assess outcomes for non-fixed fractured rib ends in segmental rib fractures.Methods This is a retrospective review of 125 patients who underwent open reduction internal fixation of flail segmental rib fractures at our urban Level 1 trauma center. Initial plain films and CT were compared with follow-up plain film imaging at 3 months to assess radiographic outcomes, fracture healing, fixation failure, or residual deformity. Clinical outcomes such as length of intensive care unit (ICU) stay, length of ventilatory support, associated pneumonia, duration until chest tube removal, and need for additional rib surgery were analyzed.Results Fixation of a single end of segmental rib fractures and flail segments was associated with decreased incidence of fracture union at 3 months postoperatively (43/55 vs 65/70, respectively; p=0.018) but failed to show any difference in fracture collapse (50/55 vs 67/70, respectively; p=0.223). There were no differences between postoperative ICU length of stay (4.18±5.54 vs 4.62±4.48 days, respectively; p=0.690), postoperative ventilatory status (29/55 vs 38/70, respectively; p=0.840), duration of ventilatory support (3.52±4.69 vs 4.34±5.87, respectively; p=0.430), or associated pneumonia (7/55 vs 8/70, respectively; p=0.770).Conclusions These data support that fixation of both sides of flail segment rib fractures results in improved rib fracture union at 3 months postoperatively. However, fixation of both sides of flail segments does not appear to result in any difference in fracture collapse or clinical perioperative outcomes.Level of Evidence Therapeutic Level IIIhttps://tsaco.bmj.com/content/10/2/e001707.full |
| spellingShingle | Nicholas Pelz Anthony Perugini James Iandoli Daniel DeGenova Anthony Melaragno Mallory Faherty Benjamin C Taylor Is fixation of a single end of flail segment rib fractures enough? Trauma Surgery & Acute Care Open |
| title | Is fixation of a single end of flail segment rib fractures enough? |
| title_full | Is fixation of a single end of flail segment rib fractures enough? |
| title_fullStr | Is fixation of a single end of flail segment rib fractures enough? |
| title_full_unstemmed | Is fixation of a single end of flail segment rib fractures enough? |
| title_short | Is fixation of a single end of flail segment rib fractures enough? |
| title_sort | is fixation of a single end of flail segment rib fractures enough |
| url | https://tsaco.bmj.com/content/10/2/e001707.full |
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