J Trauma Acute Care Surg. 2022 Jan 25. doi: 10.1097/TA.0000000000003549. Online ahead of print.
ABSTRACT
BACKGROUND: The aim of this study was to assess pain and Quality of Life (QoL) outcomes in patients with multiple painful displaced fractured ribs with and without operative fixation. Rib fractures are common and can lead to significant pain and disability. There is minimal level 1 evidence for rib fixation in non-ventilator dependent patients with chest wall injuries. We hypothesized that surgical stabilization of rib fractures (SSRF) would reduce pain and improve QoL over 6 months.
METHODS: A prospective multi-centre randomised controlled trial comparing rib fixation to non-operative management of non-ventilated patients with at least three consecutive rib fractures. Inclusion criteria were rib fracture displacement and/or ongoing pain. Pain (McGill Questionnaire) and QoL (Short Form 12) at 3 and 6 months post injury were assessed. Surgeons enrolled patients in whom they felt there was clinical equipoise. Patients who were deemed to need surgical fixation, or who were deemed to be too well to be randomized to rib fixation were not enrolled.
RESULTS: 124 patients were enrolled at four sites between 2017 and 2020. 61 patients were randomised to operative management and 63 to non-operative management. No differences were seen in the primary endpoint of Pain Rating Index at 3 months, nor in the QoL measures. Return-to-work rates improved between 3 and 6 months, favouring the operative group.
CONCLUSIONS: In this study no improvements in pain or QoL at 3 and 6 months in patients undergoing rib fixation for non-flail, non-ventilator dependent rib fractures have been demonstrated.
LEVELS OF EVIDENCE: Level 1 Therapeutic.
PMID:35081599 | DOI:10.1097/TA.0000000000003549
