Objective

Historically, patients with rib fractures were treated with analgesia and physiotherapy. Recently evidence is emerging to support surgical fixation, especially in flail segments for effective pain control, reduce respiratory complications and expedite recovery. We started our rib fixation programme in 2011 but have now expanded with a formal referral pathway developed in association with local trauma units. We aim to review experience in the Major Trauma Centre.

Methods

Retrospective analysis of patients who presented with rib fractures and subsequently underwent surgical fixation in a Major Trauma Centre from September 2011 to September 2015. Electronic and paper medical records were analysed to extract the data.

Results

44 patients underwent surgical fixation. The mean age was 61 (26-92). 57% sustained their injuries from falls. 10 patients had bilateral rib fractures. 20 patients had isolated chest injury, Injury Severity Score Mean 22 (9-45). Mean number of rib fractures was 8. The indications for surgery were respiratory compromise (6), flail chest (12) and pain (26). 2 had bilateral fixation. Mortality was 4.5% (2). Median length of stay (LOS) was 15 and post-op LOS was 9 days. Morbidity was low.

Conclusion

Surgical fixation for rib fractures has significantly increased in our Network, with improvements in analgesia and respiratory function, and likely reduction in length of stay. Mortality and morbidity is low. The indications for rib fixation are becoming better defined. Referral protocols have improved access to patients outside the Major Trauma Centre.