Rib fractures – Sira Debate

This month’s question:
What factors should influence the decision to proceed to surgical fixation of rib fractures?
Does anyone have any experience/anecdotes of rib fixation improving the clinical position of a patient?
What regional analgesic strategies have people employed and have these been successful?
This month’s very recent paper comes out of SJUH’s Thoracic team on the above topic http://jtd.amegroups.com/article/view/28087/20912

A –

There is a really good paper from Laura May in Coventry that deals with this (BJA Ed here). I think it would be interesting if we could pull the national TARN data off and look at number of patients admitted with rib fractures, those that go to ITU and those that have fractures fixed, and then compare that to our local numbers. Anecdotally I suspect that we’re a massive outlier in that we don’t appear to fix that many as there are issues with cross site working, surgeon availability, oversight of training up orthopaedic surgeons etc. There a few papers showing improved outcomes in terms of return to work and improved spirometry at six months in those who are operated on.
Food for thought!
B –

There has been growing interest in the erector spinae plane block/catheter technique over the last year or so and being used with increasing frequency and effectiveness.

Its relatively simple, safer and rarely contraindicated. Bilateral catheters have been described but I don’t think anyone at LGI has done that yet.

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