The Forgotten Frailty Fracture: A Single Centre Experience in Managing Rib Fractures in Older Patients

Hasanali David Walji and Antonio E Martin-Ucar*

Department of Cardiothoracic Surgery, University Hospitals Coventry and Warwickshire, UK

^*Correspondance to: Antonio E Martin-Ucar 

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Abstract:

Introduction: With almost 25% of the UK population being 65 or older by 2,038 there has been
a greater focus on management of frailty fractures. Despite this there is little guidance on the
management of rib fractures in this cohort of patients. Consequently, there rages on a debate
regarding the treatment of these patients, especially in respect to the use of Open Reduction and
Internal Fixation (ORIF).
Method: We aimed to assess the difference in treatment choice and outcomes (length of stay, 30
day mortality) comparing patients under 65 with those 65 or over. We retrospectively analyzed all
cases of patients admitted with isolated >2 rib fractures over a 24 month period (November 2016 to
October 2018). Statistical analysis was carried out using t test and Kaplan-Meier Survival Curve to
compare outcomes.
Results: Over the 24 month period 329 patients were identified and followed up for 30 days. In
the overall cohort, it was found patients who underwent ORIF were younger (p=0.01) but had
more fractures (p=0.01). Older patients had a longer length of stay (p=0.01) and had an increased
mortality at 30 days (p=0.01).
Conclusion: In the case of rib fractures it appears there is a great disparity between their treatment
and the treatment of other frailty fractures such as neck of femur. This is due to a lack of guidelines/
pathways regarding both choice of operative versus non-operative management and perioperative
care. We feel there is an emerging role for the wider use of open reduction and internal fixation
for older patients and also feel there needs to be a greater multidisciplinary approach to their care.

Keywords:

Rib fractures; Open reduction and Internal fixation; Frailty

Cite the Article:

Walji HD, Martin-Ucar AE. The Forgotten Frailty Fracture: A Single Centre Experience in Managing Rib Fractures in Older Patients. World J Surg Surgical Res. 2021; 4: 1286..