Surgical Stabilization for Rib Fractures

The Effect of Early Stabilization of Rib Fractures on Patient-Centered Outcomes: A Randomized Clinical Trial

The purpose of this study is to compare the usual care alone to usual care plus early surgical stabilization in adult trauma patients who have been admitted with rib fractures, to evaluate for heterogeneity of treatment effect in high risk subgroups and to determine the the impact of multiple rib fractures on post-discharge health status and time to return to work or usual physical activity.

Inclusion Criteria:

• Blunt trauma mechanism
• Severe chest wall injury (defined by one of the 3 below):

Radiographic flail segment (defined as greater than 2 fractures in greater than 3 consecutive ribs) or greater than 5 consecutive rib fractures or greater than 1 rib fractures with bicortical displacement

• At least one true rib (1-7) fractured and accessible for stabilization

Exclusion Criteria:

• Severe traumatic brain injury (best resuscitated GCS less than 8 as measured at 24 hours)
• Spinal cord injury
• Pre-existing congestive heart failure or oxygen-dependent pulmonary disease
• Any reason for which SSRF could not occur within 72 hours of admission