"Surgical stabilization of rib fractures (SSRF): the WSES and CWIS posi" by Giacomo Sermonesi, Riccardo Bertelli et al.
 

Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper

Giacomo Sermonesi, Department of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy.
Riccardo Bertelli, Department of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy.
Fredric M. Pieracci, Department of Surgery, University of Colorado School of Medicine, Denver, CO, USA.
Zsolt J. Balogh, Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia.
Raul Coimbra, Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA.
Joseph M. Galante, Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA.
Andreas Hecker, Emergency Medicine Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany.
Dieter Weber, Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia.
Zachary M. Bauman, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
Susan Kartiko, Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Bhavik Patel, Division of Trauma, Gold Coast University Hospital, Southport, QLD, Australia.
SarahAnn S. Whitbeck, Chest Wall Injury Society, Salt Lake City, UT, USA.
Thomas W. White, Intermountain Medical Center, Salt Lake City, UT, USA.
Kevin N. Harrell, Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA.
Daniele Perrina, Department of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy.
Alessia Rampini, Department of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy.
Brian Tian, Department of General Surgery, Singapore General Hospital, Singapore, Singapore.
Francesco Amico, Discipline of Surgery, School of Medicine and Public Health, Newcastle, NSW, Australia.
Solomon G. Beka, Ethiopian Air Force Hospital, Bishoftu, Oromia, Ethiopia. sologbeka@gmail.com.
Luigi Bonavina, Department of Surgery, IRCCS Policlinico San Donato, University of Milano, Milan, Italy.
Marco Ceresoli, General and Emergency Surgery Department, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy.
Lorenzo Cobianchi, Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Federico Coccolini, Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy.
Yunfeng Cui, Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China.
Francesca Dal Mas, Collegium Medicum, University of Social Sciences, Lodz, Poland.
Belinda De Simone, Department of Minimally Invasive Emergency and General Surgery, Infermi Hospital, Rimini, Italy.
Isidoro Di Carlo, Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy.
Salomone Di Saverio, General Surgery Department Hospital of San Benedetto del Tronto, Marche Region, Italy.
Agron Dogjani, Department of General Surgery, University of Medicine of Tirana, Tirana, Albania.
Andreas Fette, Pediatric Surgery, Children's Care Center, SRH Klinikum Suhl, Suhl, Thueringen, Germany.
Gustavo P. Fraga, Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil.
Carlos Augusto Gomes, Faculdade de Medicina, SUPREMA, Hospital Universitario Terezinha de Jesus de Juiz de Fora, Juiz de Fora, MG, Brazil.

Document Type

Journal Article

Publication Date

10-18-2024

Journal

World journal of emergency surgery : WJES

Volume

19

Issue

1

DOI

10.1186/s13017-024-00559-2

Keywords

Consensus; Flail chest; Guidelines; Minimally invasive plating osteosynthesis (MIPO); Multiple rib fractures; Operative reduction and internal fixation (ORIF); Rib fixation; Rib fractures; Surgical stabilization of rib fractures (SSRF); Thoracic/chest trauma injury; Video-assisted thoracoscopy surgery (VATS)

Abstract

BACKGROUND: Rib fractures are one of the most common traumatic injuries and may result in significant morbidity and mortality. Despite growing evidence, technological advances and increasing acceptance, surgical stabilization of rib fractures (SSRF) remains not uniformly considered in trauma centers. Indications, contraindications, appropriate timing, surgical approaches and utilized implants are part of an ongoing debate. The present position paper, which is endorsed by the World Society of Emergency Surgery (WSES), and supported by the Chest Wall Injury Society, aims to provide a review of the literature investigating the use of SSRF in rib fracture management to develop graded position statements, providing an updated guide and reference for SSRF. METHODS: This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of experts then critically revised the manuscript and discussed it in detail, to develop a consensus on the position statements. RESULTS: A total of 287 studies (systematic reviews, randomized clinical trial, prospective and retrospective comparative studies, case series, original articles) have been selected from an initial pool of 9928 studies. Thirty-nine graded position statements were put forward to address eight crucial aspects of SSRF: surgical indications, contraindications, optimal timing of surgery, preoperative imaging evaluation, rib fracture sites for surgical fixation, management of concurrent thoracic injuries, surgical approach, stabilization methods and material selection. CONCLUSION: This consensus document addresses the key focus questions on surgical treatment of rib fractures. The expert recommendations clarify current evidences on SSRF indications, timing, operative planning, approaches and techniques, with the aim to guide clinicians in optimizing the management of rib fractures, to improve patient outcomes and direct future research.

Department

Surgery

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