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Characteristics of hardware failure in patients undergoing surgical stabilization of rib fractures

A Chest Wall Injury Society multicenter study

Sarani, Babak MD; Allen, Rebecca BA; Pieracci, Fredric M. MD; Doben, Andrew R. MD; Eriksson, Evert MD; Bauman, Zachary M. MD; Gupta, Puneet; Semon, Greg MD; Greiffenstein, Patrick MD; Chapman, Alistair J. MD; Kim, Brian D. MD; Lottenberg, Lawrence MD; Gardner, Scott; Marasco, Silvana MD; White, Tom MD

Journal of Trauma and Acute Care Surgery: December 2019 - Volume 87 - Issue 6 - p 1277–1281
doi: 10.1097/TA.0000000000002373

BACKGROUND Surgical stabilization of rib fractures (SSRF) is increasingly used for severe rib fractures/flail chest. There are no reports discussing mechanisms of failure of implanted hardware, its clinical presentation, or consequences. The purpose of this study was to evaluate the incidence, presenting signs, and clinical sequela of hardware failure after SSRF.

METHODS A multicenter, retrospective study was performed by a group of surgeons with a large SSRF case volume. All cases with known hardware failure from January 1, 2010, to December 31, 2017, were included. The surgeon's experience at the time of hardware implantation, specific implant used, number of failures the surgeon had experienced with the same system, and time from implantation to hardware failure were recorded. Additionally, patient demographics, including age, comorbid conditions, and number and location of rib fractures were recorded. Symptomatology associated with hardware failure and need for explant and/or reimplantation of hardware was also recorded. Nonparametric statistical tests were used to compare cohorts.

RESULTS Of 1,224 patients who underwent SSRF, 38 patients with 233 rib fractures and 279 fracture segments experienced hardware failure and were enrolled in the study. Twelve patients presented more than 3 months following injury. Median age was 54 years old and 34% were active smokers. One hundred forty-four plates were implanted with a median of four plates per patient. Median number of SSRF cases by each surgeon was 100 (range, 1–280). Fractures and hardware failure were most frequent in the anterolateral/lateral region. Hardware failure was mostly due to screw migration and plate fracture. Hardware failure was asymptomatic in 40% and presented as pain in 42% of cases. Fifty-five percent of the cases required explantation of hardware, and only 10% required SSRF again. There was no difference between the acute and chronic fracture cohorts.

CONCLUSION Hardware failure after SSRF is rare and often asymptomatic. When present, it rarely requires redo SSRF.

LEVEL OF EVIDENCE Therapeutic, level V.

From the Center for Trauma and Critical Care, Department of Surgery (B.S., R.A., P.G.), George Washington University, Washington, District of Columbia; Department of Surgery (F.M.P.), Denver General Hospital; Department of Surgery (A.R.D.), Baystate Health, Springfield, Massachusetts; Department of Surgery (E.E.), Medical University of South Carolina, Charleston, South Carolina; Department of Surgery (Z.M.B.), University of Nebraska, Omaha, Nebraska; Department of Surgery (G.S.), Wright State University, Dayton, Ohio; Department of Surgery (P.G.), Louisiana State University, New Orleans, Louisiana; Department of Surgery (A.J.C.), Spectrum Health, Grand Rapids, Michigan; Department of Surgery (B.D.K.), Mayo Clinic, Rochester, Minnesota; Department of Surgery (L.L.), Florida Atlantic University, Boca Raton, Florida; Department of Surgery (S.G., T.W.), Intermountain Health, Murray, Utah; and Department of Surgery (S.M.), Alfred Hospital, Melbourne, Australia.

Submitted: May 2, 2019, Accepted: May 3, 2019, Published online: May 14, 2019.

This was an oral presentation at the annual Chest Wall Injury Society Summit in Santa Fe, NM in March 2019.

Address for reprints: Babak Sarani, MD, 2150 Pennsylvania Ave, NW, Suite 6B, Washington, DC 20037; email:

Online date: May 17, 2019

© 2019 Lippincott Williams & Wilkins, Inc.