Plates on ribs or ribs on plates? A single-center comparison of extrathoracic vs. intrathoracic techniques for rib fracture stabilization

The primary treatment of patients with rib fractures has traditionally aimed to prevent pulmonary complications with systemic and regional analgesia, promoting normal respiratory physiology. 1 Talbot B.S. Gange C.P. Chaturvedi A. Klionsky N. Hobbs S.K. Chaturvedi A. Traumatic rib injury: patterns, imaging pitfalls, complications, and treatment. Radiographics. 2017; 37: 628-651https://doi.org/10.1148/rg.2017160100 Crossref PubMed Scopus (90) Google Scholar More recently, surgical stabilization of rib fractures (SSRF) has been shown to decrease pulmonary complications and need for tracheostomy in critically ill patients with rib fractures. 2 Pieracci F.M. Lin Y. Rodil M. et al. A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures. J Trauma Acute Care Surg. 2016; 80 (Lippincott Williams and Wilkins): 187-194https://doi.org/10.1097/TA.0000000000000925 Crossref PubMed Scopus (126) Google Scholar SSRF has also been shown to improve pain scores two weeks after discharge in rib fracture patients without flail chest. 3 Pieracci F.M. Leasia K. Bauman Z. et al. A multicenter, prospective, controlled clinical trial of surgical stabilization of rib fractures in patients with severe, nonflail fracture patterns (Chest Wall Injury Society NONFLAIL). J Trauma Acute Care Surg. 2020; 88: 249-257https://doi.org/10.1097/TA.0000000000002559 Crossref PubMed Scopus (112) Google Scholar The extrathoracic, technique for SSRF was well described in 2015 by Pieracci et al. 4 Pieracci F.M. Rodil M. Stovall R.T. et al. Surgical stabilization of severe rib fractures. J Trauma Acute Care Surg. 2015; 78: 883-887https://doi.org/10.1097/TA.0000000000000581 Crossref PubMed Scopus (69) Google Scholar The technique typically begins with a muscle sparing incision over the fracture line and reduction of the fracture. The rib is then stabilized with an external plate that is secured on both sides of the fracture using drilled screws.