Surgical Stabilization of Rib Fractures in Geriatric Patients at a Level I Trauma Center – Preliminary Results
TL;DR
A multidisciplinary CWIS incorporating trauma and orthopedic expertise and an objective treatment algorithm facilitated the management of selected geriatric patients with severe rib fractures and low mortality, acceptable morbidity, and significant improvement in pulmonary functioning after SSRF.
Abstract
The role of surgical stabilization rib fractures (SSRF) in geriatric trauma patients remains controversial despite growing evidence supporting SSRF in selected patients with severe chest wall injuries. The decision to do surgical stabilization of rib fractures in the elderly patient is more complex with recommendations for surgery to be individualized on a case-by-case basis. In this preliminary report, we describe the development of a multidisciplinary Chest Wall Injury Service that utilizes a standardized treatment algorithm and the Pain-Inspiration-Cough (PIC) score to guide management of older adults with rib fractures. A retrospective descriptive review was performed of older adult trauma patients (≥65 years) undergoing SSRF after implementation of a Chest Wall Injury Service (CWIS) at an American College of Surgeons verified Level 1 Trauma Center. The service integrates trauma and orthopedic surgeons and employs radiographic criteria and PIC score assessment to assist in selection of patients for SSRF. Following the implementation of CWIS, 358 older adult patients sustained rib fractures, of whom 22 (6.1%) underwent SSRF. Mean age was 74.3 ± 6.3 years, mean Injury Severity Score was 16.1 ± 9.3, and 14 patients (64%) had flail chest. Mean time from admission to SSRF was 3.1 ± 2.2 days. One patient (4.5%) died within 30 days of surgery from cause unrelated to rib fixation. Four patients (18.2%) experienced minor complications. Incentive spirometry volumes improved significantly from 725 mL preoperatively to 1145 mL postoperatively (p < 0.001). A multidisciplinary CWIS incorporating trauma and orthopedic expertise and an objective treatment algorithm facilitated the management of selected geriatric patients with severe rib fractures. Preliminary outcomes demonstrated low mortality, acceptable morbidity, and significant improvement in pulmonary functioning after SSRF. Larger studies are needed to further evaluate this approach.