123 * TREATMENT ALTERNATIVES FOR TRAUMATIC RIB FRACTURES: COMPARISON OF OPERATIVE FIXATION AND CONSERVATIVE APPROACH

Abstract

Objectives: To explore the value of operative fixation for traumatic rib fractures.Methods: The inclusion criteria for operation were fractures which had non-united ends, severe pain, postural derangement, organized haematoma and oozing from the chest tube. Of the total 178 patients, 92 (51.7%) underwent operative rib fixation with or without non-rib fixation surgery (group A); 86 (48.3%) were treated medically with or without non-rib fixation surgery (group B). Medical treatment included non-narcotic analgesics (central acting opioid, tramadol, 5 mg orally, three or four times a day) and/or intercostal nerve blockage by long-lasting local anaesthetics. Narcotic analgesics were not used.Results: The mean Intensive Care Unit stay and time to return to normal activities/job were shorter in group A (P < 0.05). FEV1 values increased, and the dyspnoea score and pain scale decreased after treatment in both groups (P < 0.05); there was better improvement in group A (P < 0.05). Intercostal blockage requirement decreased in group A (P < 0.05), but not in group B (P = 0.58). Mortality was 3.3% in Group A, and 4.6% in group B (P = 0.63). During the follow-up time (25.9 ± 21.3 months), events were detected in two (2.2%) patients: dispersion of titanium materials in one and breaking of titanium plaque in one. In group B, 26.7% (23/86) needed analgesic premedication due to chronic pain; 3.5% (3/86) had thoracic deformity.Conclusions: Operative stabilization of multiple rib fractures by titanium plates and screws can increase patient comfort, remove pain, ameliorate pulmonary function and improve postural derangement. They can be used in the presence of associated intra- and extrathoracic injuries.