Surgical rib fracture fixation : systematic review of effectiveness, assessment of current UK practice, and development of a core outcome set

Ingoe, Helen M. A.

Medicine
July 2019

Thesis or dissertation


Rights
© 2019 Helen M A Ingoe. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.
Abstract

Aim
To synthesise contemporary evidence for rib fracture fixation, and thereby to fill the gaps in the knowledge required to inform a trial and provide recommendations for future study.

Method
A systematic review of systematic reviews and a meta-analysis of primary research were the methods used to examine the effectiveness of rib fracture fixation. Delphi consensus methods were used to survey three international stakeholder groups so as to define a core outcome set and a consensus on indications for and timing of rib fracture fixation. A United Kingdom (UK) survey assessed the provision of rib fracture care and analysis of a UK trauma database assessed the factors that predict rib fixation and the outcomes experienced by rib fracture patients.

Results
The systematic reviews and meta-analysis suggest that rib fracture fixation shortens the duration of mechanical ventilation, reduces critical care and hospital stay as well as overall mortality. UK clinical data suggests that rib fracture fixation improves these outcomes, and that early intervention confers an advantage over late fixation. With regard to which patients receive an intervention; fracture pattern, pulmonary contusion, admission to a major trauma centre, injury severity and age are all important predictors of undergoing surgery. A core outcome set was derived to include 23 outcomes. Consensus was achieved on 20 indications and 7 timings of surgery. Care of rib fracture patients in England and Wales is delivered in a variety of centres with different care protocols, referral pathways, lead specialties and rehabilitation services.

Conclusion
Further evidence is required to assess the effectiveness of rib fracture fixation. A feasibility trial is required to understand more clearly if clinicians have equipoise, patients are willing to be randomised and whether comparative care can be delivered. A trial will need to be stratified for surgical indication and further study is required to define outcome instruments.

Publisher
Hull York Medical School, The University of Hull and The University of York
Sponsor (Organisation)
Orthopaedic Research UK
Qualification level
Doctoral
Qualification name
MD
Language
English
Extent
11 MB
Identifier
hull:17726
QR Code