Long-term outcome after surgical management of symptomatic non-union rib fractures

Julia Nilsson, Eva-Corina Caragounis
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Abstract

Introduction

Traumatic chest wall injuries are common however the incidence of non-union rib fractures is unknown. Previous studies have suggested that surgical management of symptomatic non-union rib fractures could be beneficial in selected patients, although many experience persisting pain despite surgery. The aim of this study is to investigate the long-term outcome after surgical management of symptomatic non-union rib fractures.

Methods

This is a cross-sectional study including adults (≥18 years) managed surgically for symptomatic non-union rib fractures with plate fixation during the period 2010–2020 at Sahlgrenska University Hospital. Patients operated for acute chest wall injury or injury due to cardiopulmonary resuscitation were excluded. Patients answered standardized questionnaires concerning remaining symptoms and satisfaction with surgery, quality of life (QoL, EQ-5D-5L) and disability (Disability Rating Index, DRI). Lung function, movement of chest wall and thoracic spine, and shoulder function (Boström index) were assessed.

Results

Sixteen patients, 12 men and four women, with mean age 61.6±11.1 were included in the study. The mechanism of injury was trauma in 10 patients and cough-induced injuries in five patients. Lung disease was significantly more prevalent in cough-induced injuries compared to traumatic injuries, 5 vs 1 (p=0.008). The mean follow-up time was 3.5 years. Ninety-four percent were satisfied with the surgery and reported that their symptoms had decreased, although 69% had remaining symptoms, especially pain, from the chest wall. Quality of Life was decreased with EQ-5D-5L index 0.819 (0.477–0.976) and EQ-VAS 69 (10–100). Disability Rating Index was 31.5 (1.3–76.7) with problems running, lifting heavy objects, and performing heavy work. Predicted lung function was decreased with Forced Vital Capacity (FVC) 86.2±14.2%, Forced Expiratory Volume in 1 second (FEV1) 79.1±10.7% and Peak Expiratory Flow (PEF) 89.7±14.5%. Patients with cough-induced injuries had full shoulder mobility.

Conclusions

Chest wall surgery for symptomatic non-union rib fractures results in decreased symptoms and patient satisfaction in most cases despite remaining symptoms, reduced lung function, chest wall movement, and QoL and persistent disability.

手术治疗无症状不愈合肋骨骨折后的长期疗效
导言胸壁外伤很常见,但肋骨骨折不愈合的发生率尚不清楚。以前的研究表明,对症状性肋骨骨折进行手术治疗对特定患者有益,但许多患者在手术后仍有持续疼痛。本研究旨在调查无症状性肋骨不愈合骨折手术治疗后的长期疗效。方法这是一项横断面研究,研究对象包括 2010-2020 年期间在瑞典萨赫格伦斯卡大学医院接受钢板固定手术治疗的无症状性肋骨不愈合骨折的成人(≥18 岁)。因急性胸壁损伤或心肺复苏损伤而接受手术的患者除外。患者回答了有关剩余症状、手术满意度、生活质量(QoL,EQ-5D-5L)和残疾(残疾评级指数,DRI)的标准化问卷。研究还评估了肺功能、胸壁和胸椎的活动度以及肩部功能(Boström 指数)。10名患者的损伤机制为外伤,5名患者的损伤机制为咳嗽所致。与外伤相比,咳嗽引起的损伤中肺部疾病的发病率明显更高,分别为5例和1例(P=0.008)。平均随访时间为 3.5 年。94%的患者对手术感到满意,并表示症状有所减轻,但仍有69%的患者存在其他症状,尤其是胸壁疼痛。生活质量有所下降,EQ-5D-5L 指数为 0.819(0.477-0.976),EQ-VAS 为 69(10-100)。残疾评级指数为 31.5(1.3-76.7),跑步、举重物和从事重体力劳动均有问题。肺功能预测值下降,用力肺活量(FVC)为 86.2±14.2%,1 秒钟用力呼气容积(FEV1)为 79.1±10.7%,呼气峰流速(PEF)为 89.7±14.5%。结论对无症状不愈合肋骨骨折进行胸壁手术治疗后,尽管仍有症状、肺功能、胸壁活动度、生活质量和持续残疾,但大多数病例的症状减轻,患者满意度提高。
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