Outcomes after fixation of rib fractures sustained during cardiopulmonary resuscitation: A retrospective single center analysis

Nicole Maria van Veelen; Lea Buenter; Valérie Kremo; Jesse Peek; Alfred Leiser; Peter Kestenholz; Reto Babst; Frank Joseph Paulus Beeres; Fabrizio Minervini

doi:10.3389/fsurg.2023.1120399

Outcomes after fixation of rib fractures sustained during cardiopulmonary resuscitation: A retrospective single center analysis

Front Surg. 2023 Jan 23:10:1120399. doi: 10.3389/fsurg.2023.1120399. eCollection 2023.

Authors

Nicole Maria van Veelen¹, Lea Buenter¹, Valérie Kremo¹, Jesse Peek¹, Alfred Leiser², Peter Kestenholz², Reto Babst^{1

3}, Frank Joseph Paulus Beeres¹, Fabrizio Minervini²

Affiliations

¹ Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
² Department of Thoracic Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
³ Department of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland.

Abstract

Background: Historically rib fractures have been typically treated non-operatively. Recent studies showed promising results after osteosynthesis of rib fractures in trauma patients with flail segments or multiple rib fractures. However, there is a paucity of data on rib fixation after cardiopulmonary resuscitation (CPR). This study evaluated the outcomes of patients who received rib fixation after CPR.

Methods: Adult patients who received surgical fixation of rib fractures sustained during CPR between 2010 and 2020 were eligible for inclusion in this retrospective study. Outcome measures included complications, quality of life (EQ 5D 5L) and level of dyspnea.

Results: Nineteen patients were included with a mean age of 66.8 years. The mean number of fractured ribs was ten, seven patients additionally had a sternum fracture. Pneumonia occurred in 15 patients (74%), of which 13 were diagnosed preoperatively and 2 post-operatively. Six patients developed a postoperative pneumothorax, none of which required revision surgery. One patient showed persistent flail chest after rib fixation and required additional fixation of a concomitant sternum fracture. One infection of the surgical site of sternal plate occurred, while no further surgery related complications were reported. Mean EQ-5D-5L was 0.908 and the average EQ VAS was 80. One patient reported persisting dyspnea.

Conclusion: To date, this is the largest reported cohort of patients who received rib fixation for fractures sustained during CPR. No complications associated with rib fixation were reported whereas one infection after sternal fixation did occur. Current follow-up demonstrated a good long-term quality of life after fixation, warranting further studies on this topic. Deeper knowledge on this subject would be beneficial for a wide spectrum of physicians.

Keywords: flail chest; resuscitation; rib fixation; rib fracture; rib stabilization.