RIB FRACTURES WITH CONCOMITANT SPINAL FRACTURES BENEFIT FROM SURGICAL STABILIZATION

Objectives: Surgical stabilization of rib fractures has previously demonstrated benefits in patients with complex thoracic cage injuries. Limited information exists regarding patients with thoracic cage injuries and concomitant spinal injuries. We hypothesize that patient who have both thoracic cage and spinal fractures and undergo surgical fixation (FIX) will have improved outcomes compared to non fixation (NFIX) patients

Methods: All adult patients with rib injuries from years 2015-2019 were pooled from the National Trauma Data Bank. Patients were grouped by single, multiple, and flail rib fractures. Secondly, patients were grouped by rib fractures versus rib and spine fractures. All analysis was performed on R version 4.1.2. Mann-Whitney U tests were used for all two-group quantitative variables, and Kruskal-Wallis test for three-group quantitative variables as all quantitative variables failed normality tests. All categorical variables were tested with chi-squared tests.

Results: 178,818 patients with rib and spinal fracture (RFWSF) met inclusion criteria. 11,989 (6.7%) had flail chest and spinal fractures, 31,726 (17.7%) had single RFWSF, and 135,103 (75.5%) had multiple RFWSF. Multiple Rib fractures carried an increased risk of spinal fracture (55%) vs Flail Chest (42.8%) vs Single rib fracture (2.2%). Mortality with FIX RFWSF decreased by (6.1%) versus NFIX group. Whereas, mortality of FIX of rib fractures without spinal fractures (RFWO) decreased by (2.2%) vs the NFIX group. Ventilator free days for RFWSF FIX v. NFIX group were 9 vs 5 (p < 0.001) vs RFWO FIX vs NFIX group were 6 vs 3 (p < 0.001). Overall hospital length of stay (LOS) and ICU LOS were decreased in FIX groups

Conclusion: Patients with RFWSF are more likely to receive rib FIX than those with RFWO. Furthermore rib FIX in patients with RFWSF versus those with RFWO facilitates less ventilators days, shorter ICU and hospital LOS as well as decreases mortality.