Clinical Challenges in Trauma Surgery: Traumatic Rib Fractures

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Oct 6, 2022

The discussion dives into the management of traumatic rib fractures with insights into current treatment standards and ongoing controversies. Key topics include the importance of CT scans, multimodal pain control strategies, and ICU monitoring for at-risk geriatric patients. The hosts explore the rise of operative rib fixation, addressing indications for plating and technical tips for surgeons. They emphasize the need for further research to clarify best practices amidst conflicting evidence in the field.

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ADVICE

Obtain Chest CT Early

Get a chest CT for any patient with rib fractures to detect associated injuries and fully characterize fractures.
Use the CT to guide management decisions and surgical planning.

ADVICE

Admit For Pain Control And Home Prep

Admit most patients with multiple rib fractures for ~24 hours for pain control and assessment.
Arrange physical and occupational therapy and use incentive spirometry to confirm safe breathing before discharge.

ADVICE

Use Multimodal Pain Control

Use a multimodal pain regimen (acetaminophen, NSAIDs, gabapentin, muscle relaxants, lidocaine patches) to control pain without depressing respiration.
Schedule staggered meds to provide more continuous coverage and add ice/heat as adjuncts.

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In this episode, our team discusses the management of traumatic rib fractures including pearls and pitfalls. Join as we discuss the current standards of treatment as well as controversies in how to manage these patients!

Hosts:
Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST) and incoming editor-in-chief of Trauma Surgery and Acute Care Open.
Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.
David Sigmon, MD, MMEd, a PGY-7 resident at the University of Illinois at Chicago who will be a fellow at Lincoln Medical Center in the Bronx next year. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education.

LITERATURE

Terry SM, Shoff KA, Sharrah ML. Improving blunt chest wall injury outcomes: introducing the pic score. J Trauma Nurs. 2021;28(6):386-394.
https://pubmed.ncbi.nlm.nih.gov/34766933/
Witt CE, Bulger EM. Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol. Trauma Surg Acute Care Open. 2017;2(1):e000064.
https://tsaco.bmj.com/content/2/1/e000064
Utter GH, McFadden NR. Rib fractures, the evidence supporting their management, and adherence to that evidence base. JAMA Netw Open. 2020;3(3):e201591-e201591.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2763488
Dehghan N, Nauth A, Schemitsch E, et al. Operative vs nonoperative treatment of acute unstable chest wall injuries: a randomized clinical trial. JAMA Surgery. Published online September 21, 2022.
https://jamanetwork.com/journals/jamasurgery/article-abstract/2796556
Kasotakis G, Hasenboehler EA, Streib EW, et al. Operative fixation of rib fractures after blunt trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):618-626.
https://pubmed.ncbi.nlm.nih.gov/28030502/

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