1119 Rib Fractures: To Fix or Not to Fix? a Single, Major Trauma Centre's Experience

Introduction Rib fractures are a common feature of blunt chest trauma. This retrospective study assessed rib fixation vs. conservative management of thoracic trauma patients presenting to University Hospital Coventry and Warwickshire (UHCW). Method A retrospective cohort study of all trauma patients presenting to UHCW over a 7-year period (2016 – 2022) was conducted and filtered for cardiothoracic surgery (CTS) admission. In-hospital survival (IHS) and length of stay (LOS) in patients who had no surgery, open reduction, and internal fixation (ORIF) or other operations (thoracic and non-thoracic procedures) were compared. Results 3,386 trauma patients presented to UHCW over the 7-year period. Of the 1,147 patients with rib fractures admitted to CTS, 167 (14.6%) had ORIF ribs. ORIF patients had a 3-fold increase in IHS compared to those conservatively managed (p=0.002). However, there was no statistically significant difference in LOS (p=0.150). A statistically significant difference in IHS (HR 3.68 (95% CI 1.49-9.01) was also observed between ORIF patients and those who had other operations (p=0.005). Again, there was no significant difference in LOS between the groups (p = 0.212). Conclusions ORIF ribs is indicated for 3 or more consecutive rib fractures, displaced, flail segments, and severe chest wall deformity. The absolute indications for ORIF are still being debated but there is evidence that there are better survival outcomes in patients who have ORIF, as seen in our study. In conclusion, this study has shown that in blunt chest trauma, ORIF is beneficial in increasing in-hospital survival.