Introduction

Rib fractures are common in blunt chest wall trauma. The fractured ribs usually heal on their own without specific treatment, but a subset of patients have fractures that produce overlaying bone fragments that may produce severe pain, respiratory compromise, and chest wall deformity.

Most of the fractured ribs are treated with conservative non-operative care. These include aggressive pain management (epidural analgesia, rib oral analgesics and/or bracing techniques), and ventilation and tracheotomy¹ until fibrous stabilization is achieved. These treatment methods have been shown to have good results in respect to restoration of the damaged chest wall, but have a higher chest infection and mortality rates compared to surgical treatment.^{2 3}

More severe chest wall trauma is a major cause of morbidity and mortality, especially in the presence of a flail chest where paradoxical inward movement of the flail segment in inspiration is found. Patients with flail chest often require aggressive pain control, ventilation, and prolonged ICU stay.¹

About 10% of chest wall trauma cases result in a flail chest.⁴ Flail chest injuries, defined as fracture of at least three consecutive ribs in at least two locations each, are associated with a mortality rate of up to 36%.^{4 5} Flail chest injuries develop paradoxical inward movement of the flail segment which prevents effective inspiration and require prolonged mechanical ventilation which can lead to pneumonia and sepsis.⁴

The need to improve rib fracture treatment has been recognized for many years and some surgeons have been using operative approaches including plates, intramedullary devices, vertical bridging, wire, sutures, and struts to repair the chest wall. ^{2 3 4 5 6 7 8 9 10}

These attempts indicate a trend in better rib fracture treatment to improve pain control, reduce duration of mechanical ventilation, reduce ICU stays, reduce the risk for chest wall deformities and ultimately improve patient care.