Ribs Fracture Fixation – It is an Orthopaedic Bone After All! Preliminary Results from the Soroka University Medical Center, Israel

Asaf Acker 1 Evgeni Brotfien 2 Yoram Klein 2 Amir Korngreen 1 Leonid Ruderman 3 Yael Refaeli 3
1Orthopaedic Trauma Unit, Soroka University Medical Center, Israel
2Intensive Care Unit, Soroka University Medical Center, Israel
3Chest Surgery Unit, Soroka University Medical Center, Israel

Introduction: Ribs fracture fixation is regaining popularity among trauma surgeons worldwide. The surgical repair of broken ribs and flail chest was first introduced about 90 years ago but was soon abandoned with the development of modern non-invasive ventilation technology. The emergence of new fracture fixation technologies together with the understanding of the complications associated with long term ventilation – both drove attention towards the surgical repair option once again.

Methods: this is a prospective cohort study taking place at the Soroka University Medical Center, Israel. Inclusion criteria include all patients over 18 years of age with Flail chest injury or multiple ribs fractures, who were admitted to the ICU. All patients are operated within 72 hours of arrival according to the current treatment algorithm. All fractures are fixed using specified anatomic locking plates/ nails. Demographic data is collected and respiratory parameters before and after the operation is recorded and analyzed.

Results: between October 2015 and May 2016, 13 patients were treated surgically for Flail Chest and multiple ribs fracture at the Soroka University Medical center. The mean age was 44.7 and the male to female ratio was 9:4. Four patients had a flail Chest injury and nine patients had multiple ribs fracture, 3 of them bilaterally. All the respiratory parameters, e.g. FiO2 requirement, PaCO2 levels, PO2/FiO2 ratio, PEEP usage, PIP levels and the Dynamic compliance measurement demonstrated improved values post-operatively, with FiO2 requirement, PEEP use and Dynamic compliance all showing significant improvement (P=0.0004, P=0.0345 and P=0.0041 in accordance).

Conclusion: surgical repair of broken ribs is beneficial for a sub-set of patients suffering from flail chest and multiple ribs fractures, may shorten the ventilation period and prevent ventilation associated complications.