ORLANDO, Florida — In patients who have experienced blunt trauma with rib fractures but no flail segments, rib fixation is associated with significantly better survival and a shorter duration of mechanical ventilation, new data suggest.

"My message is, fix those ribs, and fix them early," said researcher Obi Okoye, MD, from the St. Louis University Hospital in Missouri.

"Rib fractures following trauma can be a source of significant morbidity, and even mortality. Data suggest that having broken ribs increases the risk of death because breathing becomes very difficult," he told Medscape Medical News.

"These patients may come into the hospital walking and talking and doing okay, but as time progresses, the condition tends to worsen. Fixing those ribs prevents that cascade from developing. The whole push is for doing this early and not waiting for complications to develop," Dr Okoye said here at the Society of Critical Care Medicine's 45th Critical Care Congress.

Although there are data to support the use of fixation in patients with flail chest, there are no large studies or guidelines to direct rib fixation in patients with multiple rib fractures without flail segments, he explained.

In their study, Dr Okoye and his colleagues analyzed data on 93,475 patients who had sustained rib fractures in 2011 from the National Trauma Data Bank.

Mean age of the study cohort was 48 years (range, 28 - 68 years), 73% of the cohort was male, and 73% of the traumas were related to motor vehicle accidents.

The team identified 13,853 patients with blunt trauma and multiple rib fractures who required mechanical ventilation; of these, 1339 (9.7%) underwent rib fixation.

Patients who underwent rib fixation did better than those who did not.

The risk for mortality was five times lower in patients who underwent rib fixation than in those who did not (P < .001), the time spent on mechanical ventilation was 2 days less (P < .001), and the time spent in the intensive care unit was 1 day less (P < .001).

"A prospective study is warranted to validate these results," Dr Okoye said. "In the meantime, I hope this study will encourage the surgical community to consider fixing these rib fractures more frequently and earlier, and not wait until patients are in absolute agony before we intervene."

Dr Okoye's team "did a nice job on this study," said Bryce Robinson, MD, from University of Washington Harborview Medical Center in Seattle, who was a comoderator of the oral session.

"The investigators are trying to answer a very difficult question that, unfortunately, was attempted in a retrospective fashion," he told Medscape Medical News. "They tried their best and I think the findings are very provocative, but unfortunately, it is going to take a prospective randomized controlled trial to determine just who should get fixed and who doesn't need to get fixed."

"It's very difficult to determine who is going to benefit from rib fixation and get better from it and who is just going to get better on their own. A prospective study is needed to answer that question," Dr Robinson said.

Dr Okoye and Dr Robinson have disclosed no relevant financial relationships.

Society of Critical Care Medicine's (SCCM) 45th Critical Care Congress: Abstract 5. Presented February 21, 2016.

Medscape Medical News © 2016  WebMD, LLC

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Cite this: Less Ventilator Time, Fewer Deaths After Rib Fixation - Medscape - Feb 25, 2016.

Freelance writer, Medscape Disclosure: Fran Lowry has disclosed no relevant financial relationships.

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