World Journal of Emergency Surgery (Oct 2024)
Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper
- Giacomo Sermonesi,
- Riccardo Bertelli,
- Fredric M. Pieracci,
- Zsolt J. Balogh,
- Raul Coimbra,
- Joseph M. Galante,
- Andreas Hecker,
- Dieter Weber,
- Zachary M. Bauman,
- Susan Kartiko,
- Bhavik Patel,
- SarahAnn S. Whitbeck,
- Thomas W. White,
- Kevin N. Harrell,
- Daniele Perrina,
- Alessia Rampini,
- Brian Tian,
- Francesco Amico,
- Solomon G. Beka,
- Luigi Bonavina,
- Marco Ceresoli,
- Lorenzo Cobianchi,
- Federico Coccolini,
- Yunfeng Cui,
- Francesca Dal Mas,
- Belinda De Simone,
- Isidoro Di Carlo,
- Salomone Di Saverio,
- Agron Dogjani,
- Andreas Fette,
- Gustavo P. Fraga,
- Carlos Augusto Gomes,
- Jim S. Khan,
- Andrew W. Kirkpatrick,
- Vitor F. Kruger,
- Ari Leppäniemi,
- Andrey Litvin,
- Andrea Mingoli,
- David Costa Navarro,
- Eliseo Passera,
- Michele Pisano,
- Mauro Podda,
- Emanuele Russo,
- Boris Sakakushev,
- Domenico Santonastaso,
- Massimo Sartelli,
- Vishal G. Shelat,
- Edward Tan,
- Imtiaz Wani,
- Fikri M. Abu-Zidan,
- Walter L. Biffl,
- Ian Civil,
- Rifat Latifi,
- Ingo Marzi,
- Edoardo Picetti,
- Manos Pikoulis,
- Vanni Agnoletti,
- Francesca Bravi,
- Carlo Vallicelli,
- Luca Ansaloni,
- Ernest E. Moore,
- Fausto Catena
Affiliations
- Giacomo Sermonesi
- Department of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital
- Riccardo Bertelli
- Department of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital
- Fredric M. Pieracci
- Department of Surgery, University of Colorado School of Medicine
- Zsolt J. Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle
- Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center
- Joseph M. Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis
- Andreas Hecker
- Emergency Medicine Department of General and Thoracic Surgery, University Hospital of Giessen
- Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital
- Zachary M. Bauman
- Department of Surgery, University of Nebraska Medical Center
- Susan Kartiko
- Department of Surgery, George Washington University School of Medicine and Health Sciences
- Bhavik Patel
- Division of Trauma, Gold Coast University Hospital
- SarahAnn S. Whitbeck
- Chest Wall Injury Society
- Thomas W. White
- Intermountain Medical Center
- Kevin N. Harrell
- Department of Surgery, University of Tennessee College of Medicine Chattanooga
- Daniele Perrina
- Department of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital
- Alessia Rampini
- Department of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital
- Brian Tian
- Department of General Surgery, Singapore General Hospital
- Francesco Amico
- Discipline of Surgery, School of Medicine and Public Health
- Solomon G. Beka
- Ethiopian Air Force Hospital
- Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, University of Milano
- Marco Ceresoli
- General and Emergency Surgery Department, School of Medicine and Surgery, Milano-Bicocca University
- Lorenzo Cobianchi
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia
- Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital
- Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University
- Francesca Dal Mas
- Collegium Medicum, University of Social Sciences
- Belinda De Simone
- Department of Minimally Invasive Emergency and General Surgery, Infermi Hospital
- Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania
- Salomone Di Saverio
- General Surgery Department Hospital of San Benedetto del Tronto
- Agron Dogjani
- Department of General Surgery, University of Medicine of Tirana
- Andreas Fette
- Pediatric Surgery, Children’s Care Center, SRH Klinikum Suhl
- Gustavo P. Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas
- Carlos Augusto Gomes
- Faculdade de Medicina, SUPREMA, Hospital Universitario Terezinha de Jesus de Juiz de Fora
- Jim S. Khan
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust
- Andrew W. Kirkpatrick
- Departments of Surgery and Critical Care Medicine, Foothills Medical Centre, University of Calgary
- Vitor F. Kruger
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas
- Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki
- Andrey Litvin
- Department of Surgical Diseases No. 3, University Clinic, Gomel State Medical University
- Andrea Mingoli
- Policlinico Umberto I University Hospital, Sapienza University of Rome
- David Costa Navarro
- Colorectal Surgery Unit, Trauma Care Committee, Alicante General University Hospital
- Eliseo Passera
- Departments of Surgery, ASST Papa Giovanni XXIII
- Michele Pisano
- Departments of Surgery, ASST Papa Giovanni XXIII
- Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari
- Emanuele Russo
- Department of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital
- Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George
- Domenico Santonastaso
- Department of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital
- Massimo Sartelli
- Department of Surgery, Macerata Hospital
- Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital
- Edward Tan
- Department of Surgery, Radboud University Medical Center
- Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences
- Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University
- Walter L. Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group
- Ian Civil
- Faculty of Medical and Health Sciences, University of Auckland
- Rifat Latifi
- Department of Surgery, Westchester Medical Center, New York Medical College
- Ingo Marzi
- Department of Trauma Surgery and Orthopedics, University Hospital Goethe University Frankfurt
- Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital
- Manos Pikoulis
- 3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA)
- Vanni Agnoletti
- Department of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital
- Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital
- Carlo Vallicelli
- Department of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital
- Luca Ansaloni
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia
- Ernest E. Moore
- Department of Surgery, University of Colorado School of Medicine
- Fausto Catena
- Department of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital
- DOI
- https://doi.org/10.1186/s13017-024-00559-2
- Journal volume & issue
-
Vol. 19,
no. 1
pp. 1 – 35
Abstract
Abstract Background Rib fractures are one of the most common traumatic injuries and may result in significant morbidity and mortality. Despite growing evidence, technological advances and increasing acceptance, surgical stabilization of rib fractures (SSRF) remains not uniformly considered in trauma centers. Indications, contraindications, appropriate timing, surgical approaches and utilized implants are part of an ongoing debate. The present position paper, which is endorsed by the World Society of Emergency Surgery (WSES), and supported by the Chest Wall Injury Society, aims to provide a review of the literature investigating the use of SSRF in rib fracture management to develop graded position statements, providing an updated guide and reference for SSRF. Methods This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of experts then critically revised the manuscript and discussed it in detail, to develop a consensus on the position statements. Results A total of 287 studies (systematic reviews, randomized clinical trial, prospective and retrospective comparative studies, case series, original articles) have been selected from an initial pool of 9928 studies. Thirty-nine graded position statements were put forward to address eight crucial aspects of SSRF: surgical indications, contraindications, optimal timing of surgery, preoperative imaging evaluation, rib fracture sites for surgical fixation, management of concurrent thoracic injuries, surgical approach, stabilization methods and material selection. Conclusion This consensus document addresses the key focus questions on surgical treatment of rib fractures. The expert recommendations clarify current evidences on SSRF indications, timing, operative planning, approaches and techniques, with the aim to guide clinicians in optimizing the management of rib fractures, to improve patient outcomes and direct future research.
Keywords
- Rib fractures
- Surgical stabilization of rib fractures (SSRF)
- Flail chest
- Multiple rib fractures
- Thoracic/chest trauma injury
- Rib fixation
