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Operative fixation of rib fracture nonunions

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Rib fractures are common injuries in trauma patients that often heal without intervention. Infrequently, symptomatic rib fracture nonunions are a complication after rib fractures. There is a paucity of literature on the surgical treatment of rib fracture nonunion. The purpose of this study was to describe the efficacy of rib fracture nonunion operative fixation with particular focus on surgical technique, healing rates, and complications.

Materials and methods

Patients aged ≥ 18 years with symptomatic rib fracture nonunions treated with open reduction and internal fixation (ORIF) with locking plates at a single urban level 1 trauma center were retrospectively reviewed. Pertinent demographic, clinical, radiographic, and surgical data were collected and analyzed.

Results

A total of 18 patients met inclusion criteria. The mean time from injury to undergoing ORIF for rib fracture nonunion was just under a year and the number of ribs plated was 2.95 ± 1.16 (1–5 ribs) with bone grafting used in six cases. All patients (100%) showed evidence of healing at an average of 2.65 ± 1.50 months (2–8 months). All patients reported a decrease in pain. No narcotic pain medication was used at an average of 3.88 ± 3.76 weeks (0–10 weeks) post-operatively. Intraoperative and postoperative complications were found in 4 (22.2%) patients.

Conclusion

This study concluded that operative fixation of symptomatic rib fracture nonunion demonstrated favorable outcomes with reduction in preoperative pain levels, decreased use of narcotic pain medication, minimal complications, and a high rate of fracture union. This described method provides symptomatic relief, reduction in pain, and promotes bony healing of the fracture nonunion without development of major complications. We suggest that operative fixation should be considered as the primary method of treatment of symptomatic rib nonunions.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Orthopedics, OhioHealth, Columbus, OH, 43228, USA

    Daniel T. DeGenova, Klay B. Miller, Tanner T. McClure & Hayden B. Schuette

  2. Grant Medical Center, OhioHealth Orthopedic Trauma and Reconstructive Surgeons, Columbus, OH, 43215, USA

    Bruce G. French & Benjamin C. Taylor

  3. OhioHealth/Doctors Hospital, 5100 West Broad Street, Columbus, OH, 43228, USA

    Daniel T. DeGenova

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  1. Daniel T. DeGenova
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Correspondence to Daniel T. DeGenova.

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Conflict of of interest

Daniel T. DeGenova, Klay B. Miller, Tanner T. McClure, Hayden B. Schuette, and Bruce G. French have nothing to disclose. Benjamin C. Taylor has the following disclosures: Zimmer Biomet: IP royalties; paid consultant; paid presenter or speaker. Innomed: IP royalities. Orthobullets.com: editorial or governing board; publishing royalties, financial or material support.

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Ethical approvement was obtained and approved for the retrospective study.

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DeGenova, D.T., Miller, K.B., McClure, T.T. et al. Operative fixation of rib fracture nonunions. Arch Orthop Trauma Surg 143, 3047–3054 (2023). https://doi.org/10.1007/s00402-022-04540-z

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  • DOI: https://doi.org/10.1007/s00402-022-04540-z

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