From the Guidelines
The treatment for a displaced rib fracture in a pediatric patient should primarily focus on pain management and supportive care, as most pediatric rib fractures heal well without surgical intervention. According to the most recent position paper on surgical stabilization of rib fractures (SSRF) by the World Society of Emergency Surgery (WSES) and the Chest Wall Injury Society 1, surgical fixation is not typically recommended for pediatric patients due to their flexible chest walls and superior healing capacity. Initial management should include acetaminophen (15 mg/kg every 4-6 hours) and/or ibuprofen (10 mg/kg every 6-8 hours) for pain control.
- Key aspects of treatment include:
- Pain management with acetaminophen and/or ibuprofen
- Encouraging deep breaths and coughing to prevent atelectasis and pneumonia
- Applying ice packs to the affected area for 15-20 minutes every 2-3 hours
- Close follow-up to monitor for complications such as pneumothorax or hemothorax
- It is essential to note that rib fractures in children should raise suspicion for potential child abuse, particularly in infants and young children without a history of significant trauma, and appropriate evaluation should be conducted, as highlighted in the position paper 1. Complete healing typically occurs within 4-6 weeks.
From the Research
Treatment for Displaced Rib Fracture in Pediatric Patients
- The optimal management of rib fractures in children is traditionally supportive care 2.
- However, surgical stabilization of rib fractures may be considered in cases of multiple bicortically displaced rib fractures, especially in those with a flail chest and/or a concomitant ipsilateral displaced midshaft clavicular fracture or sternal fracture 3.
- Surgical stabilization should be performed within the first 7 days after trauma, preferably within the first 3 days 3.
- Nonoperative treatment alternatives include epidural analgesia, thoracic paravertebral blockage, intercostal nerve block, intravenous or enteral analgesics, intrapleural analgesia, and multimodal analgesia 3.
Surgical Stabilization of Rib Fractures
- The procedure involves classifying rib fractures by location, type of fracture, and degree of displacement after obtaining thin-sliced chest computed tomography (CT) scans 3.
- The incision is selected depending on the fracture location, and the surgical technique is chosen relevant to the type of fracture 3.
- Precontoured side and rib-specific plates with threaded holes and self-tapping locking screws are preferred for surgical stabilization of rib fractures 3.
- Polymer cable cerclage is used to enhance plating of longitudinal fractures, rib fractures near the spine, osteoporotic ribs, and injuries of rib cartilage 3.
Antibiotic Use during Surgical Stabilization
- There is insufficient evidence to suggest existing peri-operative guidelines or recommendations are inadequate for patients undergoing surgical stabilization of traumatic rib and sternal fractures without pre-existing infectious process 4.
- For patients with concomitant infectious processes, the decision on duration and choice of antibiotic may be informed by existing guidelines for the concomitant infection 4.