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Original research
Long-term outcomes of surgical rib fixation in patients with flail chest and multiple rib fractures
  1. Kenichiro Uchida,
  2. Masahiro Miyashita,
  3. Shinichiro Kaga,
  4. Tomohiro Noda,
  5. Tetsuro Nishimura,
  6. Hiromasa Yamamoto,
  7. Yasumitsu Mizobata
  1. Department of Traumatology and Critical Care Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
  1. Correspondence to Dr Kenichiro Uchida, Department of Traumatology and Critical Care Medicine, Osaka City University Graduate School of Medicine School of Medicine, Osaka, Japan; cvs.uchida{at}gmail.com

Abstract

Background Recently, interest has increased in surgical fixation for severe thoracic wall injury with good short-term outcomes. However, few reports have evaluated long-term outcomes or complications. This study aimed to assess long-term quality of life and implant-related complications after rib fixation for flail chest and multiple rib fractures.

Methods We interviewed patients who had undergone rib fixation from January 2014 to December 2019 about their current ability to work and their usual life.

Results Twenty-two patients underwent rib fixation during the study period. Two patients with flail chest had already died after the surgery due to senescence; thus, follow-up information was obtained from 20 patients (91%), with a follow-up duration of 47.5 (IQR 22–58) months. The most undesirable event occurring during the study period was irritation caused by a palpable plate (n=2, 10%), probably due to the thin skin of patients over 70 years old. Eighteen patients were able to return to their usual life or same work as in the premorbid state with no complaints. Two patients are still undergoing rehabilitation due to concomitant extremities fractures. The median EQ-5D-5L index score was 0.89 (IQR 0.84–0.93). There were no implant-related complications requiring plate explantation.

Discussion We concluded that rib fixation offers good long-term benefits, with the ability of the patient with flail chest or multiple rib fractures to return to activity in the premorbid state. Elderly patients especially with thin, soft tissue may complain of irritation caused by the plate and should be informed of this prior to surgery.

Level of evidence Level IV therapeutic care/management.

  • thoracic injuries
  • rib fractures
  • thoracic surgical procedures
  • bone plates
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2020-000546

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    Footnotes

    • Contributors KU and YM designed this study and also conducted the literature search. ToN contributed to the literature search, data analysis, study design, critical revision, and writing of the article. KU and MM contributed to data collection and data interpretation. TeN contributed to the literature search, data interpretation and critical revision. SK and HY contributed to study design and critical revision. All authors read and approved the final article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval As this was a retrospective study with no additional interventions, the Institutional Review Board of Osaka City University waived the need for ethical approval for this study

    • Provenance and peer review Not commissioned; externally peer reviewed.