Ruben Hoepelman (Utrecht / NL), Frank Beeres (Lucerne / CH), Reinier Beks (Utrecht / NL), Arthur Sweet (Utrecht / NL), Frank F.A. IJpma (Groningen / NL), Koen Lansink (Tilburg / NL), Bas van Wageningen (Nijmegen / DE), Tjarda Tromp (Nijmegen / DE), Björn-Christian Link (Lucerne / CH), Nicole van Veelen (Lucerne / CH), Jochem Hoogendoorn (The Hague / NL), Mirjam de Jong (Utrecht / NL), Mark van Baal (Utrecht / NL), Luke P.H. Leenen (Utrecht / NL), Rolf Groenwold (Leiden / NL), Marijn Houwert (Utrecht / NL)
Abstract text (incl. references and figure legends)
INTRODUCTION
Patients with multiple rib fractures without a clinical flail chest are increasingly being treated with rib fixation;however, high-quality evidence to support this development is lacking.
MATERIAL & METHODS
We conducted a prospective multicenter observational study comparing rib fixation to non-operative treatment
in all patients aged 18 years and older with computed tomography confirmed multiple rib fractures without a clinical flail
chest. Three centers performed rib fixation as standard of care. For adequate comparison, the other three centers performed
only non-operative treatment. As such clinical equipoise formed the basis for the comparison in this study. Patients were
matched using propensity score matching.
RESULTS
In total 927 patients with multiple rib fractures were included. In the three hospitals that performed rib fixation, 80
(14%) out of 591 patients underwent rib fixation. From the nonoperative centers, on average 71 patients were adequately
matched to 71 rib fixation patients after propensity score matching. Rib fixation was associated with an increase in hospital
length of stay (HLOS) of 4.9 days (95%CI 0.8–9.1, p = 0.02) and a decrease in quality of life (QoL) measured by the EQ5D
questionnaire at 1 year of 0.1 (95% CI − 0.2–0.0, p = 0.035) compared to non-operative treatment. A subgroup analysis of
patients who received operative care within 72 h showed a similar decrease in QoL. Up to 22 patients (28%) who underwent
surgery experienced implant-related irritation.
CONCLUSIONS
We found no benefits and only detrimental effects associated with rib fixation. Based on these results, we do
not recommend rib fixation as the standard of care for patients with multiple rib fractures.
Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)
This work was financially supported by the DePuy Synthes (grant number DPS-TCMF-2017-036). The organization was not involved in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. All researchers are independent from the funder. All authors had full access to all of the data (includingstatistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.