Surgical management of rib fractures in severe chest trauma A case report.

Abstract

Introduction: Rib fractures are common injuries in thoracic trauma and can lead to severe complications such as pneumothorax, hemothorax, and pulmonary contusions, affecting respiratory function and increasing patient morbidity and mortality. Traditionally, treatment of these fractures has been conservative. However, surgical fixation of the ribs has emerged as an effective and viable therapeutic option for patients with severe rib fractures or thoracic instability.

Results: A 53-year-old male patient presented to the emergency department with a 36-hour history of a fall from an 8-meter height. The patient reported a loss of consciousness with spontaneous recovery. Upon arrival, the patient was alert, oriented, and in pain, with decreased respiratory and dissociated thoracoabdominal movement. Vital signs included blood pressure of 169/110 mmHg, heart rate of 80 bpm, and oxygen saturation of 88% on room air, which improved to 95% with 5 liters of oxygen. Within the first 24 hours of hospitalization, rib osteosynthesis was performed using 9-segment pure titanium clips due to the 8-meter fall. The patient remained in the Intensive Care Unit for 3 days, requiring supplemental oxygen via nasal cannula at 5 liters, without the need for high-flow oxygen or mechanical ventilation. The total hospital stay was 10 days, with chest tube removal on the 9th day and successful oxygen weaning. No complications were reported.

Conclusion: Rib osteosynthesis is an effective and safe option for patients presenting with severe thoracic trauma that can lead to flail chest, with excellent short-, medium-, and long-term outcomes. Early surgical management is necessary for better and faster recovery, prevents lung parenchymal injury, reduces pain, and is associated with a shorter stay in the Intensive Care Unit. Various rib clips and titanium bars are good options due to their ease of placement and minimal complications. Further studies are needed to provide information on long-term use so that this surgical technique can be more widely adopted.