Optimizing surgical stabilization of rib fractures using intraoperative ultrasound localization

Abstract

BACKGROUND:Surgical stabilization of rib fractures (SSRF) significantly improve the outcomes of patients with rib fractures. Ultrasound is a specific modality for localizing rib fractures. We hypothesized that use of perioperative ultrasound localization of fracture sites optimizes surgical approach and clinical outcomes. METHODS:We performed a retrospective cohort study of adult patients undergoing SSRF and compared those with and without adjunctive perioperative ultrasound fracture localization. Our primary outcome was improved surgical efficiency as measured by incision length and total operative time. Secondary clinical outcomes included numeric pain score on follow-up visit and daily morphine milligram equivalent prescribed within 30 days from discharge. RESULTS:We performed 49 surgical rib fixations between 2015 and 2020; of which, 13 (26.5%) additionally underwent ultrasound localization (26.5%). There were no significant differences between groups in age, sex, number of ribs repaired, or days till surgery. More patients in the ultrasound group had nonflail chest wall injury (76.9% vs. 27.8%, p = 0.003). Use of perioperative ultrasound was associated with shorter incision length (median, 9 vs. 15.5 cm; p = 0.0001), shorter operative time (median, 120 vs. 174 minutes; p = 0.003), less daily morphine milligram equivalent (25 vs. 68 mg, p = 0.009), and reduced numeric pain score on follow up (median, 4 vs. 7, p = 0.05). CONCLUSION:Use of perioperative ultrasound localization of rib fractures to optimize surgical approach for SSRF was associated with reduced incision length, operative time, and opioid requirements on patient discharge. We recommend considering routine perioperative localization to improve surgical approach and efficiency during SSRF.

Minimally Invasive Surgical Management of Chronic Cough-Induced Rib Fracture Non-Union: A Case Report

“…A few case reports or series describing nonunion repair for chronic pain are available, but most of these were cases of pseudoarthrosis. Very few articles described cases of hypertrophy, and most of them were treated with plate fixation [27][28][29]. As demonstrated by Marasco et al [30], the use of intramedullary fixation is attractive compared with standard plate fixation.…”

“…The strength of our case report is precisely in the minimally invasive strategy that was possible thanks to ultrasound-guided fracture localization and intramedullary fixation. Indeed, the use of perioperative ultrasound localization of rib fractures is associated with reduced incision length, operative time, and opioid requirements on patient discharge [27].…”