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Choi J, Gomez GI, Kaghazchi A, Borghi JA, Spain DA, Forrester JD. Surgical Stabilization of Rib Fracture to Mitigate Pulmonary Complication and Mortality: A Systematic Review and Bayesian Meta-Analysis. J Am Coll Surg 2020; 232:211-219.e2. [PMID: 33212228 DOI: 10.1016/j.jamcollsurg.2020.10.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Jeff Choi
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA; Department of Epidemiology and Population Health, Stanford University, Stanford, CA; Surgeons Writing About Trauma (SWAT), Stanford University, Stanford, CA.
| | - Giselle I Gomez
- Surgeons Writing About Trauma (SWAT), Stanford University, Stanford, CA; School of Medicine, Stanford University, Stanford, CA
| | - Aydin Kaghazchi
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA; Surgeons Writing About Trauma (SWAT), Stanford University, Stanford, CA; School of Medicine, Stanford University, Stanford, CA
| | - John A Borghi
- School of Medicine, Stanford University, Stanford, CA
| | - David A Spain
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA; Surgeons Writing About Trauma (SWAT), Stanford University, Stanford, CA
| | - Joseph D Forrester
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA; Surgeons Writing About Trauma (SWAT), Stanford University, Stanford, CA
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Long R, Tian J, Wu S, Li Y, Yang X, Fei J. Clinical efficacy of surgical versus conservative treatment for multiple rib fractures: A meta-analysis of randomized controlled trials. Int J Surg 2020; 83:79-88. [PMID: 32931977 DOI: 10.1016/j.ijsu.2020.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/18/2020] [Accepted: 09/04/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There are still controversies between surgical treatment and conservative treatment for multiple rib fractures (MRFs). No consensus has been reached concerning the indications and timing of surgery. In this meta-analysis, we aimed to determine the optimal treatment for MRFs. METHODS Six databases (PubMed, Medline, Embase, Cochrane, Cnki, Wanfang Database) were retrieved for all eligible randomized controlled trials (RCTs) published before January 2020. MRFs were treated either with operative reduction and internal fixation or conservative treatment. The pertinent data were retrieved. The quality of RCTs was evaluated by the modified Jadad rating scale and meta-analysis was performed using RevMan 5.3 software. RESULTS Seven RCTs involving 538 MRFs patients (260 were treated surgically vs. 278 conservatively) were included in this meta-analysis. Compared with conservative treatment, surgical treatment resulted in shorter length of hospital stay (WMD -8.48; 95% CI -11.34 to -5.63; P < 0.001), length of ICU stay (WMD -5.72; 95% CI -7.31 to -4.13; P < 0.001) and duration of mechanical ventilation (WMD -4.93; 95% CI -8.79 to -1.07; P = 0.01), with a lower risk of complications including pneumonia (RR 0.40; 95% CI 0.30 to 0.53; P < 0.001) and chest wall deformity (RR 0.07; 95% CI 0.03 to 0.14; P < 0.001). The sensitivity analysis carried out by excluding one study with significant heterogeneity showed that the rate of tracheostomy was lower in the surgical group than in the conservative group (RR 0.44; 95% CI 0.28 to 0.71; P = 0.0008). CONCLUSIONS For patients with MRFs, surgical treatment resulted in faster recovery, a lower risk of complications and better prognosis than conservative treatment.
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Affiliation(s)
- Rui Long
- Department of Emergency, Daping Hospital, Army Medical University, Chongqing, China; Medical Center of Trauma and War Injury, Daping Hospital, Army Medical University, Chongqing, China
| | - Junying Tian
- Department of Foreign Language, Chongqing Medical University, Chongqing, China
| | - Shasha Wu
- Intensive Care Unit, Daping Hospital, Army Medical University, Chongqing, China
| | - Yang Li
- Medical Center of Trauma and War Injury, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiuhua Yang
- Department of Emergency, Daping Hospital, Army Medical University, Chongqing, China; Medical Center of Trauma and War Injury, Daping Hospital, Army Medical University, Chongqing, China
| | - Jun Fei
- Department of Emergency, Daping Hospital, Army Medical University, Chongqing, China; Medical Center of Trauma and War Injury, Daping Hospital, Army Medical University, Chongqing, China.
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Harrell KN, Jean RJ, Dave Bhattacharya S, Hunt DJ, Barker DE, Maxwell RA. Late Operative Rib Fixation is Inferior to Nonoperative Management. Am Surg 2020; 86:944-949. [PMID: 32841046 DOI: 10.1177/0003134820942185] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Operative rib fixation (ORF) of traumatic rib fractures has been shown to decrease hospital length of stay (LOS), ventilator days, and mortality. ORF performed within 1 day of admission has been shown to have favorable outcomes compared to later ORF. This report examines the ORF experience over 10 years at a level I trauma center. METHODS ORF patients from January 2007-January 2018 were matched to nonoperative controls in a 1:2 ratio based on age, injury severity score (ISS), chest Abbreviated Injury Score (AIS), and head AIS. Patient demographic, injury, and outcome data were collected from the trauma registry and medical records. Hospital day of ORF was identified for each ORF patient. Hospital LOS, ICU LOS, ventilator days, and mortality were compared against matched nonoperative controls. RESULTS Ninety-five ORF patients were matched to 190 nonoperative patients. ORF patients had a higher number of rib fractures (9.6 vs 6.4, P < .001). ORF patients with short time to operation (0-2 days) had a shorter average hospital stay than those with delayed operations (11.8 vs 12.6 vs 13.4 vs 19.6 days, P = .003). ORF patients with operations performed 3-4 days and >6 days after admission also had statistically significant longer ICU LOS and ventilator days. Patient mortality was higher when ORF was performed after 6 days. DISCUSSION Early ORF may improve pulmonary function, patient outcomes, and decrease LOS. Shifting practice toward early fixation may help further solidify the benefits of this procedure in the treatment of blunt chest trauma.
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Affiliation(s)
- Kevin N Harrell
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Robert J Jean
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - S Dave Bhattacharya
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Darren J Hunt
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Donald E Barker
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Robert A Maxwell
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
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Peek J, Beks RB, Hietbrink F, Heng M, De Jong MB, Beeres FJ, Leenen LP, Groenwold RH, Houwert RM. Complications and outcome after rib fracture fixation: A systematic review. J Trauma Acute Care Surg 2020; 89:411-418. [DOI: 10.1097/ta.0000000000002716] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Santonastaso DP, de Chiara A, Russo E, Gamberini E, Musetti G, Cittadini A, Ranieri S, Coccolini F, Fugazzola P, Ansaloni L, Agnoletti V. Alternative Regional Anesthesia for Surgical Management of Multilevel Unilateral Rib Fractures. J Cardiothorac Vasc Anesth 2020; 34:1281-1284. [DOI: 10.1053/j.jvca.2019.11.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/18/2019] [Accepted: 11/23/2019] [Indexed: 12/31/2022]
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Xiao X, Zhang S, Yang J, Wang J, Zhang Z, Chen H. Surgical fixation of rib fractures decreases intensive care length of stay in flail chest patients. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:216. [PMID: 32309363 PMCID: PMC7154414 DOI: 10.21037/atm.2020.01.39] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Nonoperative treatment is currently the standard therapy for rib fractures. However, there is a trend towards surgical fixation from conservative management over the last decade. While surgical fixation of rib fractures has shown promising results, its impact on the clinical results remains unclear based on the current literature. As such, the present study aims to compare the short-term outcomes of multiple rib fracture patients treated by surgical fixation with traditional conservative management. Methods Data for patients with multiple (three or more) rib fractures admitted to our department between January 2012 and January 2019 were retrospectively collected and analyzed. Propensity score matched patients were compared between those treated with surgical rib fixation and those of nonoperatively treated. Primary outcomes were hospital length of stay for multiple rib fracture patients, and intensive care unit (ICU) length of stay for flail chest patients. Secondary outcomes included in hospital mortality, ICU usage rate, duration of ventilator support, ventilator usage rate, and pneumonia. Results The study included 1,201 patients with mean age of 50.1±12.7 years, of whom 954 (79.4%) were male. The average number of rib fractures was 6.3±2.4, with a mean injury severity score of 20.5±7.3. Among them, 563 (46.9%) patients had surgical rib fixation and 638 (53.1%) patients received nonoperative treatment. There were 191 patients with a flail chest, 133 (69.6%) had operative rib fixation and 58 (30.4%) were nonoperatively treated. After propensity score match, the hospital length of stay was not significantly differed between surgery and conservative management in multiple rib fracture patients (10.7±3.4 vs. 10.2±3.8 days, P=0.067), nor were the secondary outcomes, in terms of in hospital mortality (0.9% vs. 1.1%, P=0.704), ICU usage rate (12.3% vs. 12.9%, P=0.820), duration of ventilator support (100.1±13.9 vs. 99.8±20.7 hours, P=0.822), ventilator usage rate (12.0% vs. 12.9%, P=0.732), and pneumonia (24.3% vs. 24.9%, P=0.861). For patients with a flail chest, shorter ICU length of stay was found to be associated with surgical rib fixation comparing with nonoperative treatment (5.5±1.9 vs. 6.7±2.1 days, P=0.011). No secondary outcomes such as in hospital mortality (4.4% vs. 4.4%, P=1.000), ICU usage rate (20.0% vs. 22.2%, P=0.796), duration of ventilator support (113.1±20.4 vs. 131.2±19.5 hours, P=0.535), ventilator usage rate (20.0% vs. 20.0%, P=1.000), pneumonia (28.9% vs. 31.1%, P=0.818) were significant different between the operative and nonoperative groups. Conclusions Surgical rib fixation results in a shorter ICU length of stay in patients with a flail chest, and a comparable outcome for patients with multiple rib fractures when compared with nonoperative treatment.
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Affiliation(s)
- Xiangzhi Xiao
- Department of Thoracic Surgery, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai 201700, China
| | - Shengchao Zhang
- Department of Thoracic Surgery, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai 201700, China
| | - Juhua Yang
- Department of Thoracic Surgery, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai 201700, China
| | - Jian Wang
- Department of Thoracic Surgery, Xuhui Branch of Zhongshan Hospital, Fudan University, Shanghai 200031, China
| | - Zhilong Zhang
- Department of Thoracic Surgery, Xuhui Branch of Zhongshan Hospital, Fudan University, Shanghai 200031, China
| | - Hao Chen
- Department of Thoracic Surgery, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai 201700, China.,Department of Thoracic Surgery, Xuhui Branch of Zhongshan Hospital, Fudan University, Shanghai 200031, China
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Hsieh CH, Tsai PL, Huang CY, Chuang JF, Chou SE, Su WT, Hsu SY. Factors affecting mortality in trauma patients with more than three rib fractures. FORMOSAN JOURNAL OF SURGERY 2020. [DOI: 10.4103/fjs.fjs_24_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kazakova T, Tafen M, Wang W, Petrov R. Rescue Re-Do Inline Osteosynthesis with Wire Cerclage for Failed Rib Plating of Multilevel Rib Nonunion. ACTA ACUST UNITED AC 2019; 4:59-62. [PMID: 32342028 PMCID: PMC7185219 DOI: 10.4103/jctt.jctt_13_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Rib nonunion is a rare occurrence that requires surgical management and has a high rate of failure that may necessitate repeated intervention. We present the case of successful rescue redo repair of previously failed plating of chronic nonunion for multilevel posterior rib fractures, reinforced by wire cerclage of the osteosynthesis plate. Our objective is to illustrate the feasibility of repeated interventions, and the technique to resolve this challenging problem.
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A multicenter, prospective, controlled clinical trial of surgical stabilization of rib fractures in patients with severe, nonflail fracture patterns (Chest Wall Injury Society NONFLAIL). J Trauma Acute Care Surg 2019; 88:249-257. [DOI: 10.1097/ta.0000000000002559] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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