Introduction: Rib fractures are prevalent amongst geriatric patients, risking substantial morbidity/mortality (1). Multi-modal analgesia can be insufficient in flail chest/displaced fractures. Surgical stabilisation of rib fractures (SSRF) is infrequently considered in geriatric patients. We studied patients ≥70 years undergoing SSRF at a Major Trauma Service.
Methodology: Retrospective review of a prospectively collected database of patients ≥70 years with blunt thoracic injury admitted to St George Hospital undergoing SSRF between January 2019 and December 2023. Statistical analysis calculated median age, rib fracture/fixation characteristics, and length of stay (LOS), amongst other variables.
Results: 26 patients underwent SSRF, 38.5% female. Median 75.5 years (IQR 72.3 – 78.8). Commonest mechanism was falls (57.7%). Median Injury Severity Score 17 (IQR 13 – 21). Median Charlson Comorbidity Index 4 (IQR 3 – 4.75). Patients had median 8 rib fractures (IQR 7 – 11), 19.2% bilateral, 69.3% had flail ribs. SSRF performed median 5 days post-injury (IQR 3 – 8). Median 5 ribs plated (IQR 4.25 – 6.0), and median 100% (83.3 – 100%) of flail ribs plated. Commonest indication was uncontrolled pain (46.2%). 61.5% extubated day of SSRF, median time from SSRF to weaning oxygen 8 days (IQR 5 – 16), ICU LOS 6.12 days (IQR 3.79 – 10.6), and hospital LOS 21 days (IQR 16 – 27). Commonest complication hospital acquired infection (61.5%), mostly UTIs (48%). 19.2% developed pneumonia, 40% before SSRF. There were no plate associated complications. All survived.
Conclusion: Age should not preclude SSRF. All these patients recovered with minimal complications. Early SSRF can reduce rib fracture complications.