Does the Coexistence of Multiple Segmental Rib Fractures in Polytrauma Patients Presenting with "major" Vertebral Fracture Affect Care and Acute Outcomes?

Mohammed Ali Alvi, Joseph R. Kapurch, David V. Ivanov, Panagiotis Kerezoudis, Mohamad Bydon, Brett Freedman

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective:To determine whether operating on "major" vertebral fractures leads to premature abortion of surgery and/or other acute cardiopulmonary complications.Design:Retrospective review.Clinical Setting:Level 1 trauma center.Patients/Participants and Intervention:We retrospectively queried our institutional Trauma Rregistry for all cases presenting with concomitant rib fractures and surgically managed vertebral fractures.Main Outcome Measurements:The main outcomes included the surgical outcome (aborted vs. successfully performed), total and Intensive Care Unit length of stay (LOS), adverse discharge, mortality, and functional outcomes.Results:We found 57 cases with concomitant segmental rib fractures and surgically managed vertebral fractures. Seven patients (12%) received a rib fixation, of which 1 received before vertebral fixation and 6 after. Importantly, 4 vertebral fixation cases (7.02%) had to be aborted intraoperatively because of the inability to tolerate prone positioning for surgery. For case-control analysis, we performed propensity score matching to obtain matched controls, that is, cases of vertebral fixation but no rib fractures. On matched case-control analysis, patients with concomitant segmental rib fractures and vertebral fractures were found to have higher Intensive Care Unit LOS [median = 3 days (Inter-Quartile Range = 0-9) versus. 8.4 days, P = 0.003], whereas total LOS, frequency of complete, incomplete or functional spinal cord injury, discharge to rehab, and discharge to nursing home were found to be similar between the 2 groups.Conclusion:Our findings demonstrate that segmental rib fractures with concomitant vertebral fractures undergoing surgical treatment represent a subset of patients that may be at increased risk of intraoperative cardio-pulmonary complications and rib fixation before prone spine surgery for cases in which the neurological status is stable is reasonable.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)23-30
Number of pages8
JournalJournal of orthopaedic trauma
Volume33
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Rib Fractures
Multiple Trauma
Length of Stay
Ribs
Intensive Care Units
Propensity Score
Trauma Centers
Nursing Homes
Spinal Cord Injuries
Spine
Lung
Mortality
Wounds and Injuries

Keywords

  • prone position
  • rib fractures
  • spinal cord injury
  • trauma
  • vertebral fractures

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Does the Coexistence of Multiple Segmental Rib Fractures in Polytrauma Patients Presenting with "major" Vertebral Fracture Affect Care and Acute Outcomes? / Alvi, Mohammed Ali; Kapurch, Joseph R.; Ivanov, David V.; Kerezoudis, Panagiotis; Bydon, Mohamad; Freedman, Brett.

In: Journal of orthopaedic trauma, Vol. 33, No. 1, 01.01.2019, p. 23-30.

Research output: Contribution to journalArticle

Alvi, Mohammed Ali ; Kapurch, Joseph R. ; Ivanov, David V. ; Kerezoudis, Panagiotis ; Bydon, Mohamad ; Freedman, Brett. / Does the Coexistence of Multiple Segmental Rib Fractures in Polytrauma Patients Presenting with "major" Vertebral Fracture Affect Care and Acute Outcomes?. In: Journal of orthopaedic trauma. 2019 ; Vol. 33, No. 1. pp. 23-30.
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AB - Objective:To determine whether operating on "major" vertebral fractures leads to premature abortion of surgery and/or other acute cardiopulmonary complications.Design:Retrospective review.Clinical Setting:Level 1 trauma center.Patients/Participants and Intervention:We retrospectively queried our institutional Trauma Rregistry for all cases presenting with concomitant rib fractures and surgically managed vertebral fractures.Main Outcome Measurements:The main outcomes included the surgical outcome (aborted vs. successfully performed), total and Intensive Care Unit length of stay (LOS), adverse discharge, mortality, and functional outcomes.Results:We found 57 cases with concomitant segmental rib fractures and surgically managed vertebral fractures. Seven patients (12%) received a rib fixation, of which 1 received before vertebral fixation and 6 after. Importantly, 4 vertebral fixation cases (7.02%) had to be aborted intraoperatively because of the inability to tolerate prone positioning for surgery. For case-control analysis, we performed propensity score matching to obtain matched controls, that is, cases of vertebral fixation but no rib fractures. On matched case-control analysis, patients with concomitant segmental rib fractures and vertebral fractures were found to have higher Intensive Care Unit LOS [median = 3 days (Inter-Quartile Range = 0-9) versus. 8.4 days, P = 0.003], whereas total LOS, frequency of complete, incomplete or functional spinal cord injury, discharge to rehab, and discharge to nursing home were found to be similar between the 2 groups.Conclusion:Our findings demonstrate that segmental rib fractures with concomitant vertebral fractures undergoing surgical treatment represent a subset of patients that may be at increased risk of intraoperative cardio-pulmonary complications and rib fixation before prone spine surgery for cases in which the neurological status is stable is reasonable.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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