Impact of time interval between trauma and operation on clinical outcome in patients with delayed rib fixation

Background Surgical stabilization of rib fracture (SSRF) is a recognized salvage therapy of painful rib fracture as well as of rib fracture nonunion (SSRFN), defined as a non-bridging callus on chest CT-scan at least three months after trauma. However, some recent studies described that significant proportion of patients still experience residual pain and worsened quality of life following a delayed operation. Additionally, data on potential impact of time interval between initial trauma and surgery on patients' outcomes are missing. Aim of this study is to analyze the outcomes of patients who underwent a delayed SSRF three weeks to three months after trauma or SSRFN at least three months after trauma and the impact of the time interval between trauma and surgery on the outcomes.

Methods & Materials This prospective cohort study is a single center analysis of existing data on patients who underwent a delayed SSRF three weeks to three months after trauma as well as on patients who underwent a SSRFN at our department between January 1^st, 2012 and June 30^th, 2024. The subjective health-related quality of life was assessed using the 12-Item Short-Form (SF-12) questionnaire. Patients completed a questionnaire about pain using a numerical rating scale – NRS and were asked to assess the pain status at the timepoint to study specific visit compared to before surgery in five categories from much worse to much better. Additionally, painkiller use, satisfaction, recommendation of the surgery to another person in same comparable situation, and activity resumption were assessed.

Results Fifty one patients were included. The mean number of fixed ribs was 3 (1-6). Preliminary analysis showed that pain was much better at the timepoint of study specific visit compared to the status before surgery in 86% in both groups. No worsening of the symptoms was observed. 86% of the patients were free of pain medication, 88% could work like preoperatively. All patients would recommend this procedure to another person in comparable situation.

Conclusion In our collective of patients, the preliminary results suggest that the delayed SSRF/SSRFN could lead to a significant pain relief and improve the quality of life in a proportion of the patients higher than in the literature, independently of the time interval between trauma and delayed operation. Consequently, these procedures should be performed, especially when the pressure of suffering is high.

Publication History

Article published online:
25 August 2025