Treatment of Acute, Unstable Chest Wall Injuries

Exclusion Criteria

• •Anatomic location of rib fractures are not amenable to surgical fixation (eg fractures directly adjacent to spinal column)
• •Rib fractures primarily involving floating ribs (ribs 10-12)
• •Home Oxygen (O2) requirement
• •Other significant injuries that may require long term intubation:
• •Severe pulmonary contusion (Defined as PaO2/FIO2 ratio \<200 with radiological evidence of pulmonary infiltrates WITHIN 24 hours of THORACIC TRAUMA)
• •Severe head injury/Traumatic brain injury - (GCS ≤ 8 at 48 hrs post injury. If unable to assess full GCS due to intubation or other causes, GCS motor ≤4 at 48 hrs post injury)
• •Upper airway injury requiring long term intubation and mechanical ventilation (e.g. tracheal disruption)
• •Acute quadriplegia/quadraparesis
• •Head and neck burn injuries, or inhalation burn injuries
• •Dementia or other inability to complete follow-up questionnaires
• •Medically unstable for OR (e.g. haemodynamic instability, acidosis, coagulopathy, etc.)\* or unlikely to survive 1 year follow-up, in the opinion of the attending physician
• •Lack of informed consent from patient or substitute decision maker
• •Randomization \> 72 hours from injury
• •ORIF \> 96 hours from injury (if randomized to surgical fixation group)
• •Age \> 85