Long-term quality of life and functional outcome after rib fracture fixation

Peek, Jesse; Kremo, Valérie; Beks, Reinier B.; Veelen, Nicole M. van; Leiser, Alfred; Link, Björn‐Christian; Houwert, Roderick M.; Minervini, Fabrizio; Knobe, Matthias; Babst, Reto; Beeres, Frank J.P.

doi:10.1007/s00068-020-01470-6

Cited by 14 publications

(12 citation statements)

References 23 publications

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“…Long-term outcomes following SSRF have been studied less commonly with studies showing long-term pulmonary function and quality of life to recover to values within normal, but no significant benefit has been demonstrated compared to nonoperative management (62)(63)(64)(65)(66).…”

Section: Ssrfmentioning

confidence: 99%

What is the optimal timing to perform surgical stabilization of rib fractures?

Prins

Wijffels²,

Pieracci

2021

J Thorac Dis

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The practice of surgical stabilization of rib fractures (SSRF) for severe chest wall injury has exponentially increased over the last decade due to improved outcomes as compared to nonoperative management. However, regarding in-hospital outcomes, the ideal time from injury to SSRF remains a matter of debate. This review aims to evaluate and summarize currently available literature related to timing of SSRF. Nine studies on the effect of time to SSRF were identified. All were retrospective comparative studies with no detailed information on why patients underwent early or later SSRF. Patients underwent SSRF most often for a flail chest or ≥3 displaced rib fractures. Early SSRF (≤48-72 hours after admission) was associated with shorter hospital and intensive care unit length of stay (HLOS and ICU-LOS, respectively), duration of mechanical ventilation (DMV), and lower rates of pneumonia, and tracheostomy as well as lower hospitalization costs. No difference between early or late SSRF was demonstrated for mortality rate. As compared to nonoperative management, late SSRF (>3 days after admission), was associated with similar or worse in-hospital outcomes. The optimal time to perform SSRF in patients with severe chest wall injury is early (≤48-72 hours after admission) and associated with improved in-hospital outcomes as compared to either late salvage or nonoperative management. These data must however be cautiously interpreted due the retrospective nature of the studies and potential selection and attrition bias. Future research should focus on both factors and pathways that allow patients to undergo early SSRF.

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Section: Ssrfmentioning

confidence: 99%

What is the optimal timing to perform surgical stabilization of rib fractures?

Prins

Wijffels²,

Pieracci

2021

J Thorac Dis

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“…Reduced knee ROM (<90º) was observed in two (13.3%) patients. According to the Peek et al 20 PMMA associated with antibiotics has been widely used in the treatment of bone infections, especially in certain situations that can negatively impact the final result, such as a loose and unstable implant, highly virulent and/or multidrug-resistant organisms, and in the presence of biofilm in the maturation phase 5,7,8,11,12 . High local concentration and release of antibiotic drugs and the exothermic reaction during cement polymerization have been identified as potential benefits of using PMMA as a carrier vehicle for the elimination of local bacterial colony-forming units 24 .…”

Section: Resultsmentioning

confidence: 99%

Antibiotic cement-coated plate is a viable and efficient technique for the definitive management of metaphyseal septic nonunions of the femur and tibia

Bidolegui

Codesido

Pereira

et al. 2022

Rev. Col. Bras. Cir.

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Objective: the management of septic metaphyseal nonunions is challenging, with inconsistent outcomes. Antibiotic cement-coated implants have been demonstrated good outcome for diaphyseal infected nonunions, however there is no data in metaphyseal infected nonunions. Methods: fifteen adult patients with septic metaphyseal nonunions of the femur or tibia were treated with antibiotic cement-coated plates. The antibiotic cement-coated plate was prepared with either gentamicin or vancomycin. Outcome measures were infection control, bone healing, return to pre-injury level on daily activities, and quality of life at the last follow-up visit. A p value of <5% was considered significant. Results: Methicillin-susceptible S. aureus was isolated in 53.3% cases. Average postoperative follow-up time was 18 months. Local infection control and radiographic bone healing were adequately achieved in 93.3% patients. No patient presented recurrent symptoms of surgical site infection. Fourteen patients reported to be either able, or on the same level as before injury, with 73.3% reporting no problems in all five dimensions of the EQ-5D-3L. Persistent infection was the only variable associated with a reduced long-term quality of life. Conclusion: antibiotic cement-coated plate is a viable and efficient surgical technique for the definitive management of juxta-articular metaphyseal septic nonunions of the femur and tibia.

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“…Rib fixation in patients with multiple rib fractures or flail chest after blunt thoracic trauma has been reported as a safe procedure with good quality of life at long-term follow up when compared to a reference population ( 12 , 13 ). Furthermore, a recent meta-analysis showed a reduction of mortality for patients with flail chest who underwent rib fixation, along with a reduction of ICU length of stay, duration of mechanical ventilation and pneumonia rate ( 7 , 14 ).…”

Section: Discussionmentioning

confidence: 99%

Outcomes after fixation of rib fractures sustained during cardiopulmonary resuscitation: A retrospective single center analysis

et al. 2023

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BackgroundHistorically rib fractures have been typically treated non-operatively. Recent studies showed promising results after osteosynthesis of rib fractures in trauma patients with flail segments or multiple rib fractures. However, there is a paucity of data on rib fixation after cardiopulmonary resuscitation (CPR). This study evaluated the outcomes of patients who received rib fixation after CPR.MethodsAdult patients who received surgical fixation of rib fractures sustained during CPR between 2010 and 2020 were eligible for inclusion in this retrospective study. Outcome measures included complications, quality of life (EQ 5D 5L) and level of dyspnea.ResultsNineteen patients were included with a mean age of 66.8 years. The mean number of fractured ribs was ten, seven patients additionally had a sternum fracture. Pneumonia occurred in 15 patients (74%), of which 13 were diagnosed preoperatively and 2 post-operatively. Six patients developed a postoperative pneumothorax, none of which required revision surgery. One patient showed persistent flail chest after rib fixation and required additional fixation of a concomitant sternum fracture. One infection of the surgical site of sternal plate occurred, while no further surgery related complications were reported. Mean EQ-5D-5L was 0.908 and the average EQ VAS was 80. One patient reported persisting dyspnea.ConclusionTo date, this is the largest reported cohort of patients who received rib fixation for fractures sustained during CPR. No complications associated with rib fixation were reported whereas one infection after sternal fixation did occur. Current follow-up demonstrated a good long-term quality of life after fixation, warranting further studies on this topic. Deeper knowledge on this subject would be beneficial for a wide spectrum of physicians.

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Long-term quality of life and functional outcome after rib fracture fixation

Cited by 14 publications

References 23 publications

What is the optimal timing to perform surgical stabilization of rib fractures?

What is the optimal timing to perform surgical stabilization of rib fractures?

Antibiotic cement-coated plate is a viable and efficient technique for the definitive management of metaphyseal septic nonunions of the femur and tibia

Outcomes after fixation of rib fractures sustained during cardiopulmonary resuscitation: A retrospective single center analysis

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