Chest Wall Injury Society recommendation for surgical stabilization of nonunited rib fractures to decrease pain, reduce opiate use, and improve patient reported outcomes in patients with rib fracture nonunion after trauma

Authors

Joseph D. Forrester, From the Division of General Surgery, Department of Surgery (J.D.F., A.K.), Stanford University, Stanford, California; Division of Acute Care Surgery (Z.M.B.), University of Nebraska Medical Center, Omaha, Nebraska; HealthPartners Orthopaedics and Sports Medicine (P.A.C.), Bloomington, Minnesota; Department of Orthopaedic Surgery (P.A.C., M.L.), University of Minnesota, Minneapolis, Minnesota; Department of Orthopaedic Surgery (P.A.C.), Regions Hospital, Saint Paul, Minnesota; Sheffield Teaching Hospitals NHS Trust (J.G.E.), Sheffield, United Kingdom; and Center for Trauma and Critical Care (T.R., T.W.W.), Department of Surgery (T.R., S.K.), George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Zachary M. Bauman
Peter A. Cole
John G. Edwards
Ariel W. Knight
Michael LaRoque
Taylor Raffa
Thomas W. White
Susan Kartiko

Document Type

Journal Article

Publication Date

12-1-2023

Journal

The journal of trauma and acute care surgery

Volume

95

Issue

6

DOI

10.1097/TA.0000000000004083

Abstract

BACKGROUND: Rib fractures are common injuries which can be associated with acute pain and chronic disability. While most rib fractures ultimately go on to achieve bony union, a subset of patients may go on to develop non-union. Management of these nonunited rib fractures can be challenging and variability in management exists. METHODS: The Chest Wall Injury Society's Publication Committee convened to develop recommendations for use of surgical stabilization of nonunited rib fractures (SSNURF) to treat traumatic rib fracture nonunions. PubMed, Embase, and the Cochrane database were searched for pertinent studies. Using a process of iterative consensus, all committee members voted to accept or reject the recommendation. RESULTS: No identified studies compared SSNURF to alternative therapy and the overall quality of the body of evidence was rated as low. Risk of bias was identified in all studies. Despite these limitations, there is lower-quality evidence suggesting that SSNURF may be beneficial for decreasing pain, reducing opiate use, and improving patient reported outcomes among patients with symptomatic rib nonunion. However, these benefits should be balanced against risk of symptomatic hardware failure and infection. CONCLUSION: This guideline document summarizes the current CWIS recommendations regarding use of SSNURF for management of rib nonunion. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.

APA Citation

Forrester, Joseph D.; Bauman, Zachary M.; Cole, Peter A.; Edwards, John G.; Knight, Ariel W.; LaRoque, Michael; Raffa, Taylor; White, Thomas W.; and Kartiko, Susan, "Chest Wall Injury Society recommendation for surgical stabilization of nonunited rib fractures to decrease pain, reduce opiate use, and improve patient reported outcomes in patients with rib fracture nonunion after trauma" (2023). GW Authored Works. Paper 4082.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4082

Department

Surgery