Quality of Life in Patients With Traumatic Rib Fracture After Rib Fracture Surgery

Quality of Life in Patients With Traumatic Rib Fracture After Rib Fracture Surgery: A Prospective Cohort Study

This study is a prospective study. Patients with traumatic rib fractures are divided into control group and surgical (OP) group, depending on whether they undergo rib fracture fixation surgeries. They complete Short Form-36 and Work Quality Index (WQI) before surgery and after surgery (before discharge, post-surgery 1 month, 3 months and 6 months). The goal of this study is to examine the life quality of patients who receive surgical treatment for rib fracture by analyzing patients' response, comorbidity, vital signs (blood pressure, heart rate, respiratory rate, Glasgow Coma Scale (GCS) etc.), severity of fracture (AIS, ISS) and medical costs. The investigators hope to find the most suitable method of treatment for patients with rib fractures.

Traumatic rib fracture is one of the most common thoracic traumas. Patients often complain of severe pain of the fracture site, especially when coughing, sneezing, inhaling and lifting arms. If there is obvious displacement of the rib fracture, there are risks of life-threatening open pneumothorax, hemothorax and internal bleeding. Multiple rib fractures may even cause flail chest, leading to respiratory distress and respiratory failure.

Even patients with mild rib fractures may suffer from pain, causing movement limitations and poor sleep. Those whose occupations require heavy labors may even lose their jobs.

Large wounds and difficulties with localization and fixation made surgical interventions a poor option in the past. Thus, treatment goals were set on pain control and infection prevention. However, in recent years, there are improvements with medical imaging, endoscopy and fracture fixation instruments, so rib fracture fixations become a new treatment option. In addition, patients now ask for higher life quality after the trauma recovery, and not just passively controlling the pain and infection.

Therefore, this study is a prospective study. The investigators enrolled patients with traumatic rib fractures from the National Taiwan University Hospital and Far Eastern Memorial Hospital from July 2017 to July 2018. This study incorporated the use of Short Form-36 and Work Quality Index (WQI) to compare the control groups and the surgical (OP) groups. The participants would complete the questionnaires before surgery and after surgery (before discharge, post-surgery 1 month, 3 months and 6 months).

The goal of this study is to examine the life quality of patients who receive surgical treatment for rib fracture by analyzing patients' response, comorbidity, vital signs (blood pressure, heart rate, respiratory rate, GCS etc.), severity of fracture (AIS, ISS) and medical costs. The investigators hope to find the most suitable method of treatment for patients with rib fractures.

Inclusion Criteria:

Absolute Indications:

1. Flail chest with paradoxical respiration
2. Multiple rib fractures with uncontrolled hemothorax or pneumothorax
3. Severe thoracic trauma causing respiratory failure (ex poor blood oxygen saturation, hypercapnia, overtime intubation etc.)

Relative Indications:

1. Fractures of 3 or more ribs, with moderate amount of hemothorax or pneumothorax
2. Fractures of 3 or more ribs, with clavicle or scapula fractures, requiring surgical intervention
3. Fractures of 3 or more ribs, with obvious rib displacement and pain
4. Chronic neuropathic pain, with poor drug control
5. Symptoms due to poor healing of fracture site (ex. dyspnea or restrictive lung disease)
6. Chest deformity or other cosmetic factors
7. Other personal factors (ex. disability caused by rib fractures)

Exclusion Criteria:

1. High risk for surgery (ex. Age greater than 75 y/o, poor cardiopulmonary function, abnormal coagulation, end-stage renal disease, hepatic failure etc.)
2. Severe chest trauma, with large area of lung contusion or pulmonary embolism
3. More than 2 organs of systemic severe trauma (ex. combining head trauma, abdominal internal bleeding, abdominal organ rupture etc.)
4. Poor rib fracture site (ex. posterior axillary line, 1st-3rd rib, sub-scapula etc.)
5. Patient refuses surgery
6. current acute infection
7. Allergy to surgical instruments
8. Lack of sufficient blood supply, poor bone density or potential infection
9. Psychiatric or neuropathic conditions causing inability to obey doctor's order