Surgical versus conservative therapy for multiple rib fractures: a retrospective analysis

Background: In this study, we aimed to evaluate the clinical effects of multiple rib fracture treatments using a rib plate fixator. Methods: From June 2014 to December 2016, 110 cases of patients with multiple rib fractures were collected for our study from the 105th Hospital of PLA; 59 patients were treated by surgery, and 51 patients received conservative treatment. We compared surgical rib plate fixation with conservative treatment for patients with multiple rib fractures. Results: The hospital stay for the surgical group was 13.12 +/- 4.21 days, whereas for the conservative group, it was 18.57 +/- 5.39 days (P<0.001). The duration of the thoracic intensive care unit (ICU) stay was 4.02 +/- 1.41 days in the surgical group and 5.06 +/- 1.80 days in the conservative group (P=0.001). The indwelling thoracic drainage tube time was 5.85 +/- 1.52 days in the surgical group and 8.26 +/- 1.96 days in the conservative group (P<0.001). The index of partial pressure of arterial oxygen (PaO2) was 91.05 +/- 10.88 mmHg 24 h after surgery whereas 86.49 +/- 11.69 mmHg 24 h after conservative treatment (P=0.036). The index of partial pressure of carbon dioxide (PaCO2) was 37.80 +/- 2.86 mmHg 24 h after surgery and it was 39.08 +/- 2.46 mmHg 24 h after conservative treatment. The hospitalization cost was 6,206.44 +/- 371.42 USD for the surgical group and 4,544.61 +/- 524.79 USD for the conservative group (P<0.001). The number of rib displacement cases after treatment was 1 case in the surgical group and 2 cases in the conservative group (P=0.475). Atelectasis occurred in 10 cases in the surgical group and in 17 cases in the conservative group (P=0.046). Delayed hemopneumothorax occurred in 7 cases in the surgical group and in 16 cases in the conservative group (P=0.012). Conclusions: Surgical treatment is a safe and effective therapy for multiple rib fractures. Our data suggested that surgical treatment can significantly shorten the patients' pain-endurance time, hospitalization time, and can reduce complication incidence. Severe rib fracture patients might benefit from surgical fixation.