This is a prospective, observational trial of 50 patients who have multiple, severe rib fractures following trauma. The investigators will follow their hospital stay for outcomes (infections, length of stay and medical care) as well as their early post-hospital course.

Hypothesis:

Rib fracture repair utilizing open reduction and internal fixation with commercially available rib plating systems improves outcomes (i.e., infectious complications), decreases hospital stay and mortality.

Study Design:

This is a prospective, observational study of 50 patients who, due to their injury pattern, are operative candidates for open reduction and internal fixation with commercial available rib plating systems for one of the following indications:

1. Flail chest with/without failure to wean from the ventilator
2. Significantly displaced rib fractures with/without lung impalement
3. Symptomatic multiple rib fractures - Failure of pain control

Outcome measures to be evaluated include:

1. Hospital Mortality
2. Ventilator free days
3. Need for tracheotomy
4. Infectious Complications (pneumonia, bacteremia, UTI, empyema)
5. Hospital & ICU Days
6. Disposition following discharge

Inclusion Criteria:

• Subjects must be at least >18 years of age
• Subjects must have one of the following clinical indications:
• >3 rib flail segments with paradoxical chest wall movement
• Non-repair of defect may result in pulmonary hernia
• Minimal associated injuries
• Severely displaced fractures are significantly impeding lung expansion.
• Failure of narcotics or epidural pain catheter to control pain

Exclusion Criteria:

• Significant pulmonary contusion
• Significant brain injury (AIS 4 and/or ICP monitoring)
• Severe associated injuries which, in the opinion of the surgeon will preclude operative chest wall stabilization
• Subjects not expected to survive the 90-day follow-up period
• Known pregnancy
• Prisoners

Vanderbilt University Trauma Center.