Department of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy.
Department of Surgery, University of Colorado School of Medicine, Denver, CO, USA.
World J Emerg Surg. 2024 Oct 18;19(1):33. doi: 10.1186/s13017-024-00559-2.
Rib fractures are one of the most common traumatic injuries and may result in significant morbidity and mortality. Despite growing evidence, technological advances and increasing acceptance, surgical stabilization of rib fractures (SSRF) remains not uniformly considered in trauma centers. Indications, contraindications, appropriate timing, surgical approaches and utilized implants are part of an ongoing debate. The present position paper, which is endorsed by the World Society of Emergency Surgery (WSES), and supported by the Chest Wall Injury Society, aims to provide a review of the literature investigating the use of SSRF in rib fracture management to develop graded position statements, providing an updated guide and reference for SSRF.
This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of experts then critically revised the manuscript and discussed it in detail, to develop a consensus on the position statements.
A total of 287 studies (systematic reviews, randomized clinical trial, prospective and retrospective comparative studies, case series, original articles) have been selected from an initial pool of 9928 studies. Thirty-nine graded position statements were put forward to address eight crucial aspects of SSRF: surgical indications, contraindications, optimal timing of surgery, preoperative imaging evaluation, rib fracture sites for surgical fixation, management of concurrent thoracic injuries, surgical approach, stabilization methods and material selection.
This consensus document addresses the key focus questions on surgical treatment of rib fractures. The expert recommendations clarify current evidences on SSRF indications, timing, operative planning, approaches and techniques, with the aim to guide clinicians in optimizing the management of rib fractures, to improve patient outcomes and direct future research.
肋骨骨折是最常见的外伤性损伤之一，可能导致严重的发病率和死亡率。尽管有越来越多的证据、技术进步和越来越多的认可，创伤中心仍未普遍考虑对肋骨骨折进行手术固定（SSRF）。适应证、禁忌证、合适的时机、手术入路和使用的植入物都是正在讨论的一部分。本立场文件由世界急诊外科学会（WSES）认可，并得到胸壁损伤学会的支持，旨在对肋骨骨折管理中使用 SSRF 的文献进行综述，以制定分级立场声明，为 SSRF 提供更新的指南和参考。
本立场文件按照 WSES 方法制定。指导委员会进行文献复习并起草立场文件。然后，一个国际专家小组对稿件进行了批判性修订，并详细讨论，就立场声明达成共识。
从最初的 9928 项研究中，共选择了 287 项研究（系统评价、随机临床试验、前瞻性和回顾性比较研究、病例系列、原始文章）。提出了 39 项分级立场声明，以解决 SSRF 的八个关键方面：手术适应证、禁忌证、手术时机最佳、术前影像学评估、手术固定肋骨骨折部位、并发胸部损伤的处理、手术入路、稳定方法和材料选择。
本共识文件针对肋骨骨折手术治疗的关键焦点问题。专家建议澄清了 SSRF 适应证、时机、手术规划、方法和技术的当前证据，旨在指导临床医生优化肋骨骨折的管理，改善患者的预后，并指导未来的研究。
