From the Guidelines
Surgical stabilization of rib fractures (SSRF) is recommended for patients with flail chest or multiple and displaced rib fractures, as it has been shown to reduce morbidity, mortality, and improve quality of life 1. The treatment of rib fractures primarily focuses on pain management and preventing complications. Pain control is essential and typically involves a combination of over-the-counter medications like acetaminophen and NSAIDs such as ibuprofen. For more severe pain, your doctor may prescribe opioid medications for short-term use. Some key points to consider in the treatment of rib fractures include:
- Applying ice packs to the injured area for 15-20 minutes several times daily can reduce swelling and discomfort.
- Deep breathing exercises are crucial to prevent pneumonia, as pain may cause shallow breathing.
- Most rib fractures heal within 6-8 weeks without specific interventions beyond pain control.
- During recovery, avoid activities that worsen pain, sleep in a semi-upright position if lying flat is uncomfortable, and hold a pillow against your chest when coughing or sneezing to stabilize the area.
- Seek immediate medical attention if you experience increasing pain, difficulty breathing, fever, or coughing up blood, as these may indicate complications like pneumonia or a punctured lung. Recent studies have shown that SSRF can reduce the duration of mechanical ventilation, pneumonia rates, ICU stay, and costs compared to non-operative management (NOM) 1. Additionally, SSRF has been found to improve pulmonary function tests, reduce thoracic deformity and pain, and improve return-to-work rates 1. It is essential to note that the decision to perform SSRF should be made on a case-by-case basis, taking into account the individual patient's condition and the presence of any concomitant injuries. In general, SSRF is a cost-effective intervention that can improve clinical outcomes and reduce morbidity and mortality in patients with rib fractures, particularly those with flail chest or multiple and displaced rib fractures 1.
From the Research
Treatment Options for Rib Fractures
- Surgical stabilization of rib fractures is a recommended treatment option for 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 2
- Nonoperative treatment alternatives include epidural analgesia, thoracic paravertebral blockage, intercostal nerve block, intravenous or enteral analgesics, intrapleural analgesia, and multimodal analgesia 2, 3
- Rib fixation and intercostal analgesia have been shown to decrease ICU LOS, ventilator days, and pneumonia in patients with multiple rib fractures 4
Pain Management for Rib Fractures
- Adequate pain control is crucial in preventing complications in patients with multiple rib fractures 5
- Pharmacologic and noninvasive means of managing rib pain, including epidural anesthesia and alternative invasive methods of pain control, are available 6
- A practical guideline for managing patients with pain from rib fractures includes rapid mobilization, respiratory support, and pain management 5, 6
Surgical Stabilization Techniques
- Surgical stabilization of rib fractures involves classifying rib fractures by location, type of fracture, and degree of displacement after obtaining thin-sliced chest computed tomography (CT) scans 2
- The incision is selected depending on the fracture location, and the surgical technique is chosen relevant to the type of fracture 2
- Precontoured side and rib-specific plates with threaded holes and self-tapping locking screws are preferred for surgical stabilization of rib fractures 2