Rib Plating Offers Favorable Outcomes in Patients With Chronic Nonunion of Prior Rib Fractures

Buehler, Kerrie E.; Wilshire, Candice L.; Bograd, Adam J.; Vallières, Eric

doi:10.1016/j.athoracsur.2020.03.075

Cited by 18 publications

(30 citation statements)

References 10 publications

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“…There have been 4 case reports and 2 case series, of at least 44 patients across all studies, with rib nonunions treated solely with plate fixation sans bone grafting. [19][20][21][22][23][24][25] The majority of patients in these studies reported minimal pain and return to occupation, but there were no reported functional outcomes or radiographic follow-up in these series. De Jong et al 19 published a 2018 retrospective cohort study on 19 patients who received plate fixation without the use of bone graft.…”

Section: Discussionmentioning

confidence: 91%

“…The majority of patients (72%) reported satisfaction with surgical management and a decrease in pain levels at a mean follow-up of 36 months. In 2020, Buehler et al 25 performed a retrospective review of 24 patients with rib nonunions who underwent open reduction and internal fixation and concluded that patients undergoing this treatment had alleviated symptoms, reduced pain, and satisfactory work resumption at a median follow-up of 2 months.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes After Operative Reconstruction of Symptomatic Rib Nonunions

Ogunleye

Carlson

Thomas

et al. 2022

Journal of Orthopaedic Trauma

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25 consecutive patients with 51 nonunions with disabling pain or chronic instability were treated for nonunited rib fractures.Intervention: Rib nonunion reconstructions performed using plate and screw fixation, recannalizing the medullary canal and augmented with autogenous iliac crest bone graft.Main Outcome Measurements: Patient demographics, mechanism of injury, number of rib nonunions, and postoperative radiographs were assessed. Satisfaction, patient-reported complications, return to occupation and activity, and general health measures were captured using patient questionnaires. Results:In 25 patients, 51 painful rib nonunions were surgically treated. The average length from injury to surgical rib reconstruction was 25.1 months (range = 3-118 months; median = 12 months). Follow-up was obtained in 18 of 25 patients (72%) with a mean of 46.1 months (range = 13-139 months). All ribs achieved radiographic union at an average of 12.3 weeks (range = 8-24 weeks) after surgery. Sixteen of 18 patients (89%) reported satisfaction with surgery and 15 patients (83%) reported mild to no pain at final follow-up. Five patients had complications that all resolved after subsequent treatment.Conclusions: Successful treatment of symptomatic rib nonunion is possible using rib plates in conjunction with bone grafting and has high union rates, satisfactory results, and limited complications.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Outcomes After Operative Reconstruction of Symptomatic Rib Nonunions

Ogunleye

Carlson

Thomas

et al. 2022

Journal of Orthopaedic Trauma

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“…In a case series of 18 patients, 56% still experienced moderate or severe pain (NRS ≥ 4) at follow-up, and 32% needed additional surgery [ 14 ]. In a second series of 19 patients, 58% experienced pain with movement and 42% remained limited in activities at follow-up; 16% underwent additional surgery [ 13 ]. In another case series, two out of ten patients were not able to resume their work or activities due to persisting symptoms and one with a deep infection required additional surgery for debridement and hardware removal [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Multiple variations have been described for the surgical stabilization of rib fracture nonunions. Differences exist in the technique of surgical stabilization of rib fractures (SSRF) [6,[12][13][14][15][16], the use of bone-grafts [5,6,13,14], and additional treatment of the intercostal nerve [5,13].…”

Section: Introductionmentioning

confidence: 99%

“…These case series reported that pain improved overall and that patients were highly satisfied. Nonetheless, a considerable proportion still experienced persistent symptoms, required additional surgery, and did not return to their pre-injury functional level [ 5 , 6 , 13 , 14 ]. This limited amount of data makes it difficult to assess the relative success of current treatments of rib fracture nonunion.…”

Section: Introductionmentioning

confidence: 99%

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Outcome after surgical stabilization of symptomatic rib fracture nonunion: a multicenter retrospective case series

Wijck

Lieshout

Prins

et al. 2022

Eur J Trauma Emerg Surg

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Purpose This study aimed to determine the long-term level of pain after surgical treatment of one or more symptomatic rib fracture nonunions. Secondary aims were to evaluate the occurrence of adverse events, satisfaction, and activity resumption. The final aim was to assess the association between pain and the presence of bridging callus at the nonunified fracture. Hypothesized was that thoracic pain would diminish after surgery. Methods This retrospective case series included adults who underwent surgery for a symptomatic rib fracture nonunion from three hospitals. Symptomatic nonunion was defined as persistent pain associated with nonbridging callus of ≥1 rib fractures on a chest CT scan at ≥3 months after the initial injury. Patients completed questionnaires about pain, satisfaction, and activity resumption ≥3 months postoperatively. Results Thirty-six patients (26 men, 10 women), with a median age of 55 (P25–P75 49–62) years and 169 acute rib fractures were included. Nonunion occurred in 98 (58%) fractures of which 70 (71%) were treated surgically. After a median of 11 months (P25–P75 7–21), 13 (36%) patients reported severe pain, in contrast to 26 (72%) preoperatively. Patients who underwent intercostal neurectomy or neurolysis in addition to surgical stabilization less often reported pain reduction. Twenty-six (72%) had postoperative complications, for which 12 (33%) underwent additional surgery, mostly for persistent pain. The majority (n = 27; 75%) was satisfied with their functional recovery. Of patients who had paid work pre-trauma, 65% had resumed working. Conclusion Most patients reported less pain and better daily functioning after surgical stabilization of symptomatic rib fracture nonunions, although causality cannot be proven with this retrospective case series. Additional intercostal nerve treatment was not associated with pain relief. Despite surgery-related complications being common, patient satisfaction was high. Level of evidence: Level V. Study type: Therapeutic.

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