Assessing the Impact of Reduced L1 Bone Density on Surgical Stabilisation of Rib Fractures in Elderly Patients: A Study on Fracture Nonunion Rates, Analgesia Usage and Hospital Length of Stay

Introduction

Rib fractures following falls are common among patients over 70 years of age. While nonoperative management is standard, surgical stabilisation of rib fractures (SSRF) is increasingly performed in selected elderly patients despite concerns about frailty and comorbidities. Although osteoporosis significantly increases fracture risk, rib fractures have not traditionally been categorised as fragility fractures.

Methods

This study retrospectively evaluated bone mineral density (BMD), represented by L1 vertebral Hounsfield units (HU) and correlated clinical outcomes in patients with rib fractures from trauma. A control group of 100 age- and sex-matched nontrauma patients was included for comparison.

Results

Overall, trauma patients exhibited higher mean L1 HU values, 125.0, compared to controls, 105.5 (p = 3 × 10⁻⁵). Within the patients sustaining rib fractures, the low-energy trauma group had lower mean L1 HU values (112.6) than those from high-energy trauma (133, p = 0.002), suggesting a link between lower BMD and susceptibility to rib fractures. Low BMD (L1 HU ≤ 110) was not associated with worse clinical outcomes such as hospital length of stay, analgesia requirements or fracture healing, whether managed operatively or nonoperatively. Low BMD did not affect rib union post-SSRF, with no hardware failures. These results suggest that low BMD alone should not contraindicate SSRF.

Conclusion

The authors recommend routine osteoporosis screening using opportunistic L1 HU measurement on trauma CT scans, particularly in elderly patients sustaining low-energy trauma, to facilitate early osteoporosis management and reduce future fracture risk.