TY - JOUR
T1 - Radiographic rib fracture nonunion and association with fracture classification in adults with multiple rib fractures without flail segment
T2 - A multicenter prospective cohort study
AU - Van Wijck, Suzanne F.M.
AU - Van Diepen, Max R.
AU - Prins, Jonne T.H.
AU - Verhofstad, Michael H.J.
AU - Wijffels, Mathieu M.E.
AU - Van Lieshout, Esther M.M.
AU - Blokhuis, Taco J.
AU - Boersma, Doeke
AU - De Loos, Erik R.
AU - Flikweert, Elvira R.
AU - IJpma, Frank F.A.
AU - Kleinveld, Sanne
AU - Knops, Simon P.
AU - Pull ter Gunne, Albert F.
AU - Spanjersberg, W. Richard
AU - Van der Bij, Gerben
AU - Van Eijck, Floortje C.
AU - Van Huijstee, Pieter J.
AU - Van Montfort, Gust
AU - Vermeulen, Jefrey
AU - Vos, Dagmar I.
AU - FixCon study group
N1 - Funding Information:
This study is supported by grants from The Netherlands Organization for Health Research and Development (ZonMw ; Reference No. 852001921 ), the OTC Foundation (Reference No. 2017-JVMW ), Stichting Coolsingel (Reference No. 573 ), and Johnson and Johnson DePuy Synthes. The funders of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of this manuscript.
Funding Information:
This study is supported by grants from The Netherlands Organization for Health Research and Development (ZonMw; Reference No. 852001921 ), the OTC Foundation (Reference No. 2017-JVMW ), Stichting Coolsingel (Reference No. 573 ), and Johnson and Johnson DePuy Synthes . The funders of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of this manuscript
Publisher Copyright:
© 2024 The Author(s)
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Background: Rib fracture nonunion is a probable cause of chronic pain following chest trauma, although its prevalence remains unknown. The aims of this study were to determine rib fracture nonunion prevalence following nonoperative management and to determine if presence of nonunion was associated with the number of rib fractures, or the rib fracture classification of anatomical location, type, and displacement. Methods: This multicenter prospective cohort study included trauma patients with three or more fractured ribs but without a flail segment, who participated in the nonoperative management group of the FixCon trial between January 2019 and June 2022. The number and classification of rib fractures were assessed on trauma chest CT. Chest CTs conducted six months post-trauma were evaluated for the presence of nonunion. Radiological characteristics of nonunions were compared with normally healed rib fractures using the Mann-Whitney U, ?2 test, and Fisher's exact test as appropriate. A generalized linear model adjusted for multiple observations per patient when assessing the associations between nonunion and fracture characteristics. Results: A total of 68 patients were included with 561 post-traumatic fractures in 429 ribs. Chest CT after six months revealed nonunions in 67 (12 %) rib fractures in 29 (43 %) patients with a median of 2 (P25-P75 1–3) nonunions per patient. Nonunion was most commonly observed in ribs seven to 10 (20–23 %, p < 0.001, adjusted p = 0.006). Nonunion occurred in 14 (5 %) undisplaced, 22 (19 %) offset, and 20 (23 %) displaced rib fractures (p < 0.001). No statistically significant association between rib fracture type and nonunion was found. Conclusions: Forty-three percent of patients with multiple rib fractures had radiographic nonunion six months after trauma. Fractures in ribs seven to 10 and dislocated fractures had an increased risk of rib fracture nonunion.
AB - Background: Rib fracture nonunion is a probable cause of chronic pain following chest trauma, although its prevalence remains unknown. The aims of this study were to determine rib fracture nonunion prevalence following nonoperative management and to determine if presence of nonunion was associated with the number of rib fractures, or the rib fracture classification of anatomical location, type, and displacement. Methods: This multicenter prospective cohort study included trauma patients with three or more fractured ribs but without a flail segment, who participated in the nonoperative management group of the FixCon trial between January 2019 and June 2022. The number and classification of rib fractures were assessed on trauma chest CT. Chest CTs conducted six months post-trauma were evaluated for the presence of nonunion. Radiological characteristics of nonunions were compared with normally healed rib fractures using the Mann-Whitney U, ?2 test, and Fisher's exact test as appropriate. A generalized linear model adjusted for multiple observations per patient when assessing the associations between nonunion and fracture characteristics. Results: A total of 68 patients were included with 561 post-traumatic fractures in 429 ribs. Chest CT after six months revealed nonunions in 67 (12 %) rib fractures in 29 (43 %) patients with a median of 2 (P25-P75 1–3) nonunions per patient. Nonunion was most commonly observed in ribs seven to 10 (20–23 %, p < 0.001, adjusted p = 0.006). Nonunion occurred in 14 (5 %) undisplaced, 22 (19 %) offset, and 20 (23 %) displaced rib fractures (p < 0.001). No statistically significant association between rib fracture type and nonunion was found. Conclusions: Forty-three percent of patients with multiple rib fractures had radiographic nonunion six months after trauma. Fractures in ribs seven to 10 and dislocated fractures had an increased risk of rib fracture nonunion.
KW - Chest wall injury
KW - Chronic pain
KW - Fracture healing
KW - Nonunion
KW - Thoracic trauma
U2 - 10.1016/j.injury.2024.111335
DO - 10.1016/j.injury.2024.111335
M3 - Article
SN - 0020-1383
JO - Injury-International Journal of the Care of the Injured
JF - Injury-International Journal of the Care of the Injured
IS - 5
M1 - 111335
ER -