March 31, 2020
Rib fractures, also known as broken or cracked ribs, are a common traumatic injury and account for 10% of admissions for blunt chest trauma. Both the young and elderly can suffer rib fracture injuries as a result of motor vehicle accidents, recreational activities, assault or falls from heights.
Though painful, most rib fractures are not life-threatening and therefore are treated with conservative methods such as pain medication and rest. However, more complex fractures can pose serious health hazards and may require more extensive care such as rib fixation surgery.
Rib fracture complications
The chest’s rib cage is constructed to contain and protect vital internal organs. The curvature of the ribs add structure, connected through several layers of muscle and attached to the spine for added stability.
When injury or fractures occur within the rib cage, lung functionality may become compromised and morbidity chances increase. Pain while breathing or coughing is the most common symptom, however, more severe pulmonary issues can occur with decreased breathing ability and a diminished ability to cough and clear secretions. These pulmonary complications can develop life-threatening cases such as pneumonia or respiratory failure.
Severe rib fractures can also lead to further complications including damage to the cavity’s organs such as a punctured lung. Complex fractures may lead to misaligned or displaced edges of the bone, compromising the chest’s protective structure. Multiple breaks in multiple places can cause segments to separate and float freely, moving independently in the cavity causing flail chest.
Why rib fixation surgery?
Rib fixation surgery has shown to benefit patients over the last 2 decades. Also known as rib plating, rib fixation surgery uses materials and technologies designed to successfully support the chest wall, reducing pain, the duration of mechanical ventilation, hospital stay, ICU time and further complications such as pulmonary infection or pneumonia.
Rib fixation surgery’s main goal is stabilizing the chest wall, holding the injured ribs in the correct anatomic place to allow for proper healing, and eliminate any further functional challenges associated with the condition.
How to know if rib fixation surgery is the right option
There is no specific treatment for rib fractures. Most simple rib fractures are not life-threatening and are treated nonsurgically with pain management, oxygen support and rest. If there are less than 3 fractures, no displacement and no associated organ injuries, conservative care is often recommended.
Rib fixation surgery may be an option should the severity of the rib fracture potentially cause further damage. Patients with 3 or more fractures, rib displacement or those having failed to wean from ventilator support should be considered for operative care as rib fractures causing reduced pulmonary function or complex fractures are more susceptible to pulmonary complications.
Surgery is often an option for patients exhibiting symptoms such as:
- Severe, chronic rib pain
- Difficulty breathing or need for mechanical ventilation
- Inability to clear the lungs through coughing
- Deformity of the chest wall
- Pulmonary herniation
- A clicking sensation when breathing
- Underlying lung injury
How rib fixation surgery is done
Surgeons will use previous X-rays or CT scans to guide decisions in appropriate patient positioning and incision sites. Dependent upon the fracture, patients are positioned on their side, face down on their stomach, or horizontally face up.
General anesthesia will be administered, putting the patient into a painless sleep. During the operation, titanium plates will be used to stabilize fractures. The appropriate length of plate is measured, cut and contoured to the rib shape. Screws are used to secure the plate on both sides of the rib, maximum structurability. Once the rib cavity contour is restored, and the surgeon has made all necessary steps for future healing, sutures will close the incision sites.
During the operation, not all ribs may be fixed. Preference is given to the most displaced and unstable. Stability of the chest wall can usually be achieved with 1 or 2 fixed fractures. The surgeon will focus on using plates to support those necessary in regaining chest wall stability, improve symptoms of the condition and eliminate further complications.
After the surgery
Antibiotics and pain medications may be prescribed after the surgery. Daily respiratory exercises and early mobilization are also recommended during recovery. As multiple rib fractures are often accompanied by other injuries, management of those conditions are also a focus.
It is important to follow all advice given by healthcare professionals. Rib fractures can take roughly 6 weeks to heal. During this time, heavy lifting, sports and other strenuous activity should be avoided. Pain is an important indicator of healing. As pain decreases, physical activities may slowly be increased.
Find the right care
Dr. Andrea Pakula provides patients with the highest levels of expertise and personalized care. Contact Dr. Pakula today for your surgery needs.