Surgical fixation of rib fractures: how I do it

Gregor J. Kocher, Mohammad Al-Hurani, Fabrizio Minervini


Chest wall trauma is common worldwide. The majority of cases are a result of blunt mechanisms. Among these injuries, rib fractures are considered the most frequent type of clinically significant blunt thoracic trauma sequelae and are associated with considerable morbidity and mortality. Despite a large number of cases annually, there are no internationally recognized guidelines for rib fracture treatment yet. This controversy in treatment options can be attributed to the lack of high-level convincing clinical research that confirms the benefits of surgical treatment over conservative treatment measures. Over the last 100 years, rib fixation has been carried out infrequently using non-specific materials due to lack of specific rib fixation systems. However, a substantial advancement in materials (e.g., low profile titanium plates) and technologies (e.g., angle-stable locking screws) was achieved in the last decade. Despite these developments, so far no clinical study has proven the superiority of one system over another. In this article, we would like to share our experience in this field including indications for surgical rib fixation and how we perform such procedures.