Current Status of Rib Plating: Hardware Failure When and How?
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TRAUMA SURGERY (J DIAZ, SECTION EDITOR)
Current Status of Rib Plating: Hardware Failure When and How? Vincent Butano1 • James A. Zebley1 • Babak Sarani1
Published online: 26 May 2020 Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Surgical stabilization of rib fractures (SSRF) has been shown to decrease morbidity and mortality in patients with multiple rib fractures. This has led to a concomitant increase in the procedure, but the complications are just now being described in the literature. The purpose of this review is to focus on the current understanding of hardware failure after rib fixation. Recent Findings A recent study from the Chest Wall Injury Society (CWIS) found that hardware failure is relatively rare and often asymptomatic thus not requiring routine postoperative imaging or reoperation. When hardware failures occur, they tend to occur on the lateral and posterolateral columns. Patients who undergo fixation for chronic fractures may be at higher risk for complications. Summary Hardware failure is a rare complication of SSRF and rarely requires reoperation. Postoperative imaging should be based on symptoms. Keywords Surgical stabilization of rib fractures Rib plating Hardware failure Flail chest Flail segment
This article is part of the Topical Collection on Trauma Surgery. & Babak Sarani [email protected] 1
Department of Surgery, Center for Trauma and Critical Care, George Washington University, 2150 Pennsylvania Ave, NW, Suite 6B, Washington, DC 20037, USA
Introduction Chest wall injury is extremely common resulting in roughly 200,000 admissions per year [1, 2]. Rib fractures result in extreme pain, difficulty breathing, decreased secretion mobilization, and, in very severe cases such as flail chest, inherent chest wall/bellows failure. The sequelae of this injury pattern vary greatly but these patients can develop hypoventilation and require prolonged mechanical ventilation with associated nosocomial pneumonia. The vast majority of rib fractures are treated non-operatively with aggressive pain control and early mobilization. Current pharmacologic therapies include NSAIDs, acetaminophen, ketamine and lidocaine infusions, gabapentinoids, opioids and local analgesia such as intercostal nerve blocks and axial anesthesia. Although multimodal combinations of these various modalities are helpful, patients with severely displaced fractures often have pain that remains refractory to medical management alone. Rib fractures are commonly considered to be a benign injury, but the consequences can be severe. Bulger et al. showed that patients 65 years and older have twice the morbidity and mortality of those younger than 65 years old, and the mortality increases by nearly 20% for each additional rib fracture [3•]. These patients often require aggressive pain control and early mobilization to minimize morbidity and mortality. Patients with flail chest or multiple, displaced non-flail rib fractures benefit from SSRF as a means to optimize pain control
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