Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
Division of Acute Care Surgery, Department of Surgery, Grady Memorial Hospital, Atlanta, GA, 30303, USA.
Injury. 2024 Dec;55(12):111930. doi: 10.1016/j.injury.2024.111930. Epub 2024 Oct 3.
Surgical stabilization of rib fractures (SSRF) has shown benefits for rib fracture patients. However, the incidence of SSRF performed remains low. We compare our institution's rib fracture patients meeting criteria for SSRF versus those actually receiving the operation, hypothesizing a significant portion are not undergoing SSRF.
A retrospective review of rib fracture patients presenting to our Level 1 trauma center from 1/2016 to 4/2023. Patients were categorized as those who met SSRF inclusion criteria versus those who didn't based on the 2023 Chest Wall Injury Society (CWIS) SSRF Guidelines. Basic demographics were obtained. Patients meeting SSRF criteria were divided into those who received SSRF versus those who didn't. Outcomes of interest included type and frequency of SSRF indications and frequency of absolute/relative contraindications. Descriptive statistics were used. Median test and t-test were used for statistical analysis. Statistical significance was set at p < 0.05.
A total of 3,432 patients presented with ≥1 rib fracture(s). Of those, 1,573(45.8 %) met SSRF inclusion criteria. These patients were predominantly male, with mean age of 57.4(±18.5) and a similar Injury Severity Score but significantly higher chest-Abbreviated Injury Score of 3 (Interquartile range 3,4)(p = 0.048). Only 458(29.1 %) patients underwent SSRF, leaving 1,115(70.9 %) managed non-operatively, of which 215(19.3 %) were ventilated and "failure to wean from the ventilator" was the most common (81.4 %) indication for SSRF. Of the 900(80.7 %) non-ventilated patients managed non-operatively, 659 (69.9 %) had ≥two indications for SSRF, 382(34.3 %) had zero relative contraindications and 394(35.3 %) had one relative contraindication for SSRF. Lastly, 52.6 % of patients in this cohort had reported "clicking/popping" of their fractures.
Only 29.1 % of patients meeting criteria for SSRF had the operation based on data from our institution. There may be additional opportunity to benefit this cohort of patients meeting SSRF criteria but not undergoing surgery.
外科固定肋骨骨折（SSRF）已显示出对肋骨骨折患者的益处。然而，进行 SSRF 的发生率仍然较低。我们比较了我院符合 SSRF 标准的肋骨骨折患者与实际接受手术的患者，假设很大一部分患者未进行 SSRF。
回顾性分析 2016 年 1 月至 2023 年 4 月期间我院 1 级创伤中心收治的肋骨骨折患者。根据 2023 年胸壁损伤协会（CWIS）SSRF 指南，患者分为符合 SSRF 纳入标准的患者和不符合 SSRF 纳入标准的患者。获得基本人口统计学资料。将符合 SSRF 标准的患者分为接受 SSRF 治疗的患者和未接受 SSRF 治疗的患者。感兴趣的结局包括 SSRF 适应证的类型和频率以及绝对/相对禁忌证的频率。采用描述性统计。中位数检验和 t 检验用于统计分析。统计学意义设定为 p < 0.05。
共有 3432 例患者至少有 1 处肋骨骨折。其中，1573 例（45.8%）符合 SSRF 纳入标准。这些患者主要为男性，平均年龄为 57.4（±18.5），损伤严重程度评分相似，但胸部简明损伤评分明显较高，为 3（四分位距 3，4）（p = 0.048）。只有 458 例（29.1%）患者接受了 SSRF，1115 例（70.9%）患者接受了非手术治疗，其中 215 例（19.3%）接受了机械通气，“无法从呼吸机上撤机”是 SSRF 的最常见适应证（81.4%）。在 900 例（80.7%）非机械通气患者中，659 例（69.9%）有≥2 个 SSRF 适应证，382 例（34.3%）无相对禁忌证，394 例（35.3%）有 1 个相对禁忌证。最后，该队列中有 52.6%的患者报告有“骨折处咔哒声/弹响声”。
根据我院的数据，只有 29.1%符合 SSRF 标准的患者接受了手术。可能还有更多机会使符合 SSRF 标准但未接受手术的这部分患者受益。
