Abstract
Rib fractures are a painful and potentially disabling injury. The most severe manifestation, flail chest, is a potentially life threatening injury which can lead to respiratory failure. Two prospective randomised trials have shown a clear benefit of operative stabilisation of fractured ribs in flail chest patients in terms of short term hospital outcomes and longer term quality of life measures. However, despite the available evidence for benefits achieved by operative stabilization of flail chest, it has not become standard management. The reasons appear to be lack of consensus as to the particular injuries that require intervention, how the ribs should be fixed and what devices should be used. In fact, currently, there are no commercially available prostheses that have been designed specifically for rib fixation. This paper reviews the current evidence for operative fixation of fractured ribs and the available prostheses. Emphasis is given to the newer prostheses under development which are specific for rib fixation. Most of these have not reached clinical testing but have reported bench-testing results. There are a number of patents pending with interesting novel designs which could potentially revolutionise this surgical field.
Keywords: Rib fixation, flail chest, open reduction internal fixation, rib splint, rib prosthesis, Rib fractures, pneumonia, sepsis, tracheostomy, polyglycolic acid, polyglactin, neurovascular bundle, posterolateral thoracotomy, U shaped plate
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