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Outcomes After Operative Management of Symptomatic Rib Nonunion

Gauger, Erich M. MD*; Hill, Brian W. MD; Lafferty, Paul M. MD*; Cole, Peter A. MD*

Journal of Orthopaedic Trauma: June 2015 - Volume 29 - Issue 6 - p 283–289
doi: 10.1097/BOT.0000000000000254
Original Article

Objective: To report the outcomes of rib reconstruction after painful nonunion.

Design: Retrospective case series.

Setting: Level I trauma center.

Patients/Participants: Between November 2007 and May 2013, 10 patients who presented with 16 rib nonunions and disabling pain were treated with reconstruction of their nonunited rib fractures.

Intervention: Rib nonunion reconstruction predominately with iliac crest bone graft and a tension band plate with a locked precontoured plating system for ribs.

Main Outcome Measurements: Demographic data, mechanism of injury, and number of rib nonunions were recorded. Operative procedure, length of follow-up, complications, Short Form Survey 36, and a patient questionnaire were also captured and documented.

Results: Eight of the 10 patients sustained their original fractures from a fall. Outcomes were available for the 10 patients at a mean follow-up of up of 18.6 months (range, 3–46 months). All 16 ribs went on to union with a mean time from reconstruction to union of 14.7 weeks (range, 12–24 weeks). At final follow-up, the mean mental and physical component Short Form Survey 36 scores were 54.4 and 43.5, respectively. Eight of the 10 patients were able to return to work and/or previous activities without limitations. Complications included 1 wound infection that resolved after irrigation and debridement with adjunctive antibiotics. One symptomatic implant was removed.

Conclusions: Ten patients with 16 symptomatic rib nonunions were reconstructed using autologous bone graft and implant/mesh fixation manifesting in successful union with improved patient function and a low rate of complications.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Supplemental Digital Content is Available in the Text.

*Department of Orthopaedic Surgery, Regions Hospital, University of Minnesota, Saint Paul, MN; and

Department of Orthopaedic Surgery, Saint Louis University Hospital, St. Louis, MO.

Reprints: Peter A. Cole, MD, Department of Orthopaedic Surgery, Regions Hospital, 640 Jackson St, Mailstop 11503L, St Paul, MN 55101 (e-mail:

Presented in part at the Annual Meeting of the American Academy of Orthopaedic Surgeons, March 19–23, 2013, Poster p516, Chicago, IL.

P. A. Cole is supported by a research grant from Synthes, Inc, has received honoraria from AOF and AONA, and is a consultant for Synthes, Inc. The other authors report no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions this article on the journal's Web site (

Accepted October 29, 2014

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