Most rib fractures will heal on their own without complications but there are selected patients that do benefit from rib fracture repair. Patients with flail chest,a severely fractured chest wall that cannot maintain proper respiratory movement, and those with a chest wall defect, a ‘caved in’ area of the chest that may also include an open wound, should be considered for rib fracture repairs if other injuries don’t preclude it. Randomized clinical trials have shown that patients with flail chest who undergo rib repair have fewer days in the intensive care unit (ICU) on mechanical ventilation , lower pneumonia rates, and return to work sooner. Patients with significant brain injuries and pulmonary contusions are not good candidates for repair.
Patients with displaced rib fractures that persist in movement and have unrelenting pain after 7 – 10 days may also benefit from rib fracture repair, although this indication is unproven. Rib fracture non-union, that is, a fracture that has not healed 2 – 3 months after injury is also a potential repair indication.
With the goal of improving the durability of fixation of rib fractures over the techniques currently available and with the additional goal of developing a minimally invasive technique, OHSU surgeons helped develop a novel repair plate known as the U-plate (figure box). The design of the U-plate theoretically overcomes the inherent softness of the human rib by grasping the rib over its superior margin and by securing the plate with anterior to posterior locking screws that do not rely on screw purchase in bone.
In a biomechanical comparison of the U-plate (4.6 cm in length) with a standard anterior locking plate (9.5 cm in length) in a simulated deep breathing test, U-plated cadaver ribs lost only 2% stiffness after 50,000 cycles compared to a loss of stiffness of 9% in anterior-plated ribs. The U-plate is Food and Drug Administration (FDA) approved for rib fracture repair. OHSU, in cooperation with Acute Innovations, LLC (www.acuteinnovations.com) is conducting a clinical trial (OHSU link) of U-plate rib fracture repair.