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A multicenter, prospective, controlled clinical trial of surgical stabilization of rib fractures in patients with severe, nonflail fracture patterns (Chest Wall Injury Society NONFLAIL). | LitMetric

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

From the Department of Surgery, Division of Trauma, Denver Health Medical Center (F.M.P., K.L.), Denver Colorado; Department of Surgery, Division of Trauma, University of Nebraska Medical Center (Z.B.), Omaha, Nebraska; Department of Surgery, Division of Trauma, Medical University of South Carolina (E.A.E.), Charleston, South Carolina; Department of Surgery, Division of Trauma, St. Mary's Medical Center (L.L.), West Palm Beach, Florida; Department of Surgery, Division of Trauma, Intermountain Medical Center (S.M.), Murray, Utah; Department of Surgery, Division of CT Surgery, St. Joseph Health (L.P.), Mission Hospital, Mission Viejo, California; Department of Surgery, Division of Trauma, George Washington University (B.S.), Washington, District of Columbia; Department of Surgery, Division of Trauma, Wright State University/Miami Valley Hospital (G.S.), Dayton, Ohio; Department of Surgery, Division of Trauma, Carolinas Medical Center (B.T.), Charlotte, North Carolina; Department of Surgery, Division of Trauma, The Queens Medical Center (F.Z.), Honolulu, Hawaii; Department of Surgery, Division of Trauma, Sanford Health (C.D.), Fargo, North Dakota; Department of Surgery, Division of Trauma, Baystate Medical Center (A.R.D.), Springfield, Massachusetts.

Published: February 2020

AI Article Synopsis

  • A study was conducted to evaluate the effectiveness of surgical stabilization of rib fractures (SSRF) in patients with severely displaced rib fractures who do not have flail chest, comparing it to traditional medical management.
  • The clinical trial involved 110 subjects, with 51 undergoing SSRF and results showing significantly lower pain scores and improved quality of life for the surgical group at a 2-week follow-up.
  • Additionally, the SSRF group experienced lower narcotic consumption and fewer complications related to the pleural space compared to the non-surgical group, suggesting that SSRF can be beneficial for these patients.

Article Abstract

Background: The efficacy of surgical stabilization of rib fracture (SSRF) in patients without flail chest has not been studied specifically. We hypothesized that SSRF improves outcomes among patients with displaced rib fractures in the absence of flail chest.

Methods: Multicenter, prospective, controlled, clinical trial (12 centers) comparing SSRF within 72 hours to medical management. Inclusion criteria were three or more ipsilateral, severely displaced rib fractures without flail chest. The trial involved both randomized and observational arms at patient discretion. The primary outcome was the numeric pain score (NPS) at 2-week follow-up. Narcotic consumption, spirometry, pulmonary function tests, pleural space complications (tube thoracostomy or surgery for retained hemothorax or empyema >24 hours from admission) and both overall and respiratory disability-related quality of life (RD-QoL) were also compared.

Results: One hundred ten subjects were enrolled. There were no significant differences between subjects who selected randomization (n = 23) versus observation (n = 87); these groups were combined for all analyses. Of the 110 subjects, 51 (46.4%) underwent SSRF. There were no significant baseline differences between the operative and nonoperative groups. At 2-week follow-up, the NPS was significantly lower in the operative, as compared with the nonoperative group (2.9 vs. 4.5, p < 0.01), and RD-QoL was significantly improved (disability score, 21 vs. 25, p = 0.03). Narcotic consumption also trended toward being lower in the operative, as compared with the nonoperative group (0.5 vs. 1.2 narcotic equivalents, p = 0.05). During the index admission, pleural space complications were significantly lower in the operative, as compared with the nonoperative group (0% vs. 10.2%, p = 0.02).

Conclusion: In this clinical trial, SSRF performed within 72 hours improved the primary outcome of NPS at 2-week follow-up among patients with three or more displaced fractures in the absence of flail chest. These data support the role of SSRF in patients without flail chest.

Level Of Evidence: Therapeutic, level II.

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Source
http://dx.doi.org/10.1097/TA.0000000000002559DOI Listing

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