Published online Nov 26, 2019. doi: 10.12998/wjcc.v7.i22.3718
Peer-review started: August 21, 2019
First decision: September 9, 2019
Revised: October 8, 2019
Accepted: October 15, 2019
Article in press: October 15, 2019
Published online: November 26, 2019
Rib fracture is caused by a large force impacting the chest wall and is a typical chest injury, accounting for 40%-80% of chest traumas. The severity of injury varies with the number of rib fractures, the presence or absence of angulation, and the age and physical condition of the patient; the injury may be accompanied by severe complications.
There are two types of treatments for rib fractures: Surgical treatment and conservative treatment. Surgical treatment involves rib fracture internal fixation in the literature, and this method is often reported in select patients with injuries to the flail chest. Conservative treatment includes analgesia and ventilator support. The clinical manifestations of patients with rib fractures vary widely.
Some patients who meet the diagnostic criteria for an image of flail chest have no abnormal breathing, have satisfactory pain management, and have mild respiratory complications. In contrast, many patients have inadequate long-term analgesia, respiratory distress, and hypoxemia due to a long-standing substantial smoking history or the presence of primary pulmonary diseases; analgesic treatment is not valid in these patients. Even if the imaging findings of rib fractures are relatively mild, rib fractures may cause severe position limitation, respiratory distress, and hypoxemia. Even further, mechanical ventilation may be needed, so the "clinical flail chest" condition should receive more attention.
Seventy-eight patients from our hospital with severe non-continuous thoracic rib fractures from September 2016 to September 2018 were enrolled in our study. Thirty-nine patients underwent surgical treatment, and 39 underwent conservative surgery. The surgical treatment group received surgery performed with titanium plates, and the screws were inserted with open reduction and internal fixation. The conservative treatment group received analgesia and symptomatic treatment. The pain scores at 72 h, 1 wk, 2 wk, 4 wk, 6 wk, 3 mo, and 6 mo were compared, and the SF-36 quality of life scores were compared at the 3rd and 6th months.
Pain relief in the surgical group was significantly better than that in the conservative group at each time point. The SF-36 scores were significantly higher in the conservative group than in the surgical group at1mo and 6 mo.
Patients with severe non-flail chest rib fractures have a better quality of life following surgical treatment than following conservative treatment, and surgical treatment is also useful for relieving pain.
We should pay more attention to the physiological functions and clinical manifestations of patients with severe rib fractures. In patients with non-flail chest rib fractures, surgical treatment is feasible and effective.