Hardware Infection From Surgical Stabilization of Rib Fractures Is Lower Than Previously Reported

Abstract

Surgical stabilization of rib fractures (SSRF) is an emerging therapy for the treatment of patients with traumatic rib fractures. Despite the demonstrated benefits of SSRF, there remains a paucity of literature regarding the complications from SSRF, especially those related to hardware infection. Currently, literature quotes hardware infection rates as high as 4%. We hypothesize that the hardware infection rate is much lower than currently published. MethodsThis is an IRB-approved, four-year multicenter descriptive review of prospectively collected data from January 2016 to June 2022. All patients undergoing SSRF were included in the study. Exclusion criteria included those patients less that 18 years of age. Basic demographics were obtained: age, gender, Injury Severity Score (ISS), Abbreviate Injury Scale-chest (AIS-chest), flail chest (yes/no), delayed SSRF more than two weeks (yes/no), number of patients with a pre-SSRF chest tube, and number of ribs fixated. Primary outcome was hardware infection. Secondary outcomes included mortality rate and hospital length of stay (HLOS). Basic descriptive statistics were utilized for analysis. ResultsA total of 453 patients met criteria for inclusion in the study. Mean age was 63 ± 15.2 years and 71% were male. Mean ISS was 17.3 ± 8.5 with a mean AIS-chest of 3.2 ± 0.5. Flail chest (three consecutive ribs with two or more fractures on each rib) accounted for 32% of patients. Forty-two patients (9.3%) underwent delayed SSRF. The average number of ribs stabilized was 4.75 ± 0.71. When analyzing the primary outcome, only two patients (0.4%) developed a hardware infection requiring reoperation to remove the plates. Overall HLOS was 10.5 ± 6.8 days. Five patients suffered a mortality (1.1%), all five with ISS scores higher than 15 suggesting significant polytrauma. ConclusionThis is the largest case series to date examining SSRF hardware infection. The incidence of SSRF hardware infection is very low (<0.5%), much less than quoted in current literature. Overall, SSRF is a safe procedure with low morbidity and mortality.

Suture fixation of traumatic rib fracture flail segment with Klebsiella osteomyelitis

“…Unfortunately, there is no consensus on strategies to reduce implant infections in patients with concurrent infections at a different anatomic location or SSRF in a contaminated field [ 2 ]. Implant infections following SSRF are relatively rare but can be extremely morbid and involve multiple rounds of wound debridement, antibiotic bead placement, negative-pressure wound therapy, and implant removal [ 3 , 4 ]. Methods to avoid the placement of a prosthetic plate in patients with a risk for infection have been described and vary from non-operative management, bioprosthetic brace implantation, and suture transfixation of rib fractures [ 5 , 6 , 8 , 10 ].…”

“…Despite the known benefits of surgical stabilization of rib fractures (SSRF), there is no consensus on the management of rib fractures in patients with traumatic wound contamination or an ongoing but separate infection [ 2 ]. Although infrequent (0.5–4 %), plate infection following SSRF is extremely morbid and all efforts should be undertaken to minimize its occurrence [ 3 , 4 ]. Various methods have been described to avoid the placement of permanent hardware in trauma patients with high risks for infections, including the utilization of bioprosthetic plates, closed-incision negative pressure therapy (ciNPT), or non-operative management [ [5] , [6] , [7] , [8] ].…”

Das schwere Thoraxtrauma: Indikationen und Kontraindikationen für operative und nicht operative Versorgungsstrategien

“…Jede operative Intervention birgt jedoch auch eine eigene Komplikationsentität, auch wenn der frühzeitige OP-Zeitpunkt darauf ausgerichtet ist, Komplikationen im nicht operativen Managementso wie es bisher üblich warabzuwenden. Eine spätere Versorgung führt zu einer erhöhten Rate an Komplikationen sowie einem geringeren Benefit für den Patienten durch die operative Stabilisierung [3,4,5,53]. In der aktuellen Literatur wird eine operationsbedingte Infektionsrate zwischen 0,5 % und 4 % berichtet und passt damit in den Kontext auch vergleichbarer anderer osteosynthetischer Versorgungen [42,53].…”

“…Eine spätere Versorgung führt zu einer erhöhten Rate an Komplikationen sowie einem geringeren Benefit für den Patienten durch die operative Stabilisierung [3,4,5,53]. In der aktuellen Literatur wird eine operationsbedingte Infektionsrate zwischen 0,5 % und 4 % berichtet und passt damit in den Kontext auch vergleichbarer anderer osteosynthetischer Versorgungen [42,53]. Während jedoch die implantatassoziierten Infektionen nach einer Osteosynthese grundsätzlich in ähnlichen Versorgungsprinzipien mündenwie Wunddébridement, systemische und lokale Antibiotikatherapie sowie Implantatentfernung und ggf.…”

“…Vakuumverbandversorgungenist eine Infektion an der Thoraxwand eine risikobehaftete Lokalisation. Ein potenzielles Risiko einer intrathorakalen Infektion ist mit hoher Priorität abzuwenden [53,54]. In einer Metaanalyse zeigten Choi et al eine Implantatversagensrate in Höhe von ca.…”