A Multicenter, Prospective, Controlled Clinical Trial of Surgical Stabilization of Rib Fractures in Patients with Severe, Non-flail Fracture Patterns.

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 ≥ 3 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 two week follow up. Narcotic consumption, spirometry, pulmonary function tests, pleural space complications (tube thoracostomy or surgery for retained hemothorax or empyema \u3e 24 hours from admission) and both overall and respiratory disability-related quality of life (RD-QoL) were also compared. RESULTS: 110 subjects were enrolled. There were no significance difference between subjects who selected randomization (n=23) vs. 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 non-operative groups. At two week follow up, the NPS was significantly lower in the operative, as compared to the non-operative group (2.9 vs. 4.5, p CONCLUSIONS: In this clinical trial, SSRF performed within 72 hours improved the primary outcome of NPS at two week follow up among patients with ≥ 3 displaced fractures in the absence of flail chest. These data support a role for SSRF in patients without flail chest. LEVEL OF EVIDENCE: Level II, Therapeutic