Rib Healing and Heterotopic Ossification After Surgical Stabilization of Rib Fractures

Background: Little is known about the rate of rib fracture healing after Surgical Stabilization of Rib Fractures (SSRFs). We sought to evaluate the radiographic evidence of rib healing and hypertrophic ossification (HO) in patients after SSRFs. Methods: A single-center retrospective cohort study was conducted on all patients who had undergone SSRFs from 1 January 2010 to 31 March 2023 and had a computed tomography (CT) of the chest performed greater than 6 months after SSRFs. The rib fracture locations were mapped on the initial trauma CT scan and evaluated on the follow-up CT scan for healing and HO formation. Results: A total of 254 SSRF cases were evaluated, 21 patients met the inclusion criteria; out of 208 fractures, 109 underwent SSRFs. The median time to follow-up CT scan was 17(7-88) months. Overall, 95% of the fractures healed completely. Seventy percent of the non-union fractures were in posterior or paraspinal locations on ribs 8-10. HO was noted in nine patients and seen as early as 8 months post-operatively. A significant association was identified between the fixation method used to perform SSRFs (89% vs. 11%, p = 0.024) and operative day (6(0-9) vs. 2(2-5), p = 0.023). Conclusions: Non-union of rib fractures is uncommon after SSRFs. Many of these fractures involve the posterior or paraspinal lower rib cage. HO between fractures is common after SSRFs.