Pain Management of Multiple Rib Fractures based on Early Reduction and Fixation in Patients without Intensive Care Unit

Objective: Blunt thoracic traumas are often complicated with rib fractures. The decision- making process of the treatment approaches not clear for clinicians. So, we aim to investigate the effect of surgical intervention on pain management of patients as treatment indication. Methods: Cases with 3 or more rib fractures were evaluated in our study. Between 2014-2018, 367 patients with multiple rib fractures were admitted to our hospital. Of the 367 patients, 238 were included in this study. Among them 84 cases with multiple rib fractures that underwent surgery within fist 36 hours, 27 cases were operated after the 7th day 127 patients were managed conservatively. The results of hospitalization time, pneumonia, rates, thoracic deformity rates on 6.month thorax computerized tomography, intercostal blockage requirement, postoperative 6.month quality of life questionnaire for pain and clinical outputs were retrospectively analyzed. Results: The average hospitalization was found that it was significantly different in favor of the surgical group (z = 6.674; p 0.001). Thoracic deformity rates, intercostal blockage requirement was found to be different between the surgery and non-surgery groups (χ2=7.149;p 0.001), (χ2=22.462;p 0.001). Pain and quality of life scores had also significant difference in favor of the surgical group, respectively (z = 9.270; p 0.001) and (z = 8.796; p 0.001). Additionally, there was a statistical difference in pneumonia rates (p= 0.020). We did not reach a statistically significant result between the early and late groups in pain 1 and pain 2 results (p1: 0.727, p2: 0.069). Conclusions: There is no consensus on the treatment of rib fractures. The results of our study suggest that open rib reduction and fixation can be a better treatment option than the surveillance only approach in terms of pneumonia rates, hospitalization time, thoracic deformity rates and pain management.