North Pacific Surgical Association
Prolonged pain and disability are common after rib fractures

Presented at the 99th Annual Meeting of the North Pacific Surgical Association, November 9–10, 2012, Spokane, WA.
https://doi.org/10.1016/j.amjsurg.2012.12.007Get rights and content

Abstract

Background

The contribution of rib fractures to prolonged pain and disability may be underappreciated and undertreated. Clinicians are traditionally taught that the pain and disability of rib fractures resolves in 6 to 8 weeks.

Methods

This study was a prospective observation of 203 patients with rib fractures at a level 1 trauma center. Chest wall pain was evaluated by the McGill Pain Questionnaire (MPQ) pain rating index (PRI) and present pain intensity (PPI). Prolonged pain was defined as a PRI of 8 or more at 2 months after injury. Prolonged disability was defined as a decrease in 1 or more levels of work or functional status at 2 months after injury. Predictors of prolonged pain and disability were determined by multivariate analysis.

Results

One hundred forty-five male patients and 58 female patients with a mean injury severity score (ISS) of 20 (range, 1 to 59) had a mean of 5.4 rib fractures (range, 1 to 29). Forty-four (22%) patients had bilateral fractures, 15 (7%) had flail chest, and 92 (45%) had associated injury. One hundred eighty-seven patients were followed 2 months or more. One hundred ten (59%) patients had prolonged chest wall pain and 142 (76%) had prolonged disability. Among 111 patients with isolated rib fractures, 67 (64%) had prolonged chest wall pain and 69 (66%) had prolonged disability. MPQ PPI was predictive of prolonged pain (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.4 to 2.5), and prolonged disability (OR, 2.2; 95% CI, 1.5 to 3.4). The presence of significant associated injuries was predictive of prolonged disability (OR, 5.9; 95% CI, 1.4 to 29).

Conclusions

Prolonged chest wall pain is common, and the contribution of rib fractures to disability is greater than traditionally expected. Further investigation into more effective therapies that prevent prolonged pain and disability after rib fractures is needed.

Section snippets

Methods

All injured patients evaluated in the Oregon Health & Science University (OHSU) emergency department or inpatient units from July 2005 to January 2008 were screened for rib fractures. Patients with rib fractures confirmed by radiologist interpretation of plain films or computed tomographic scan were contacted for enrollment within 14 days of injury. Exclusion criteria included patients 15 years or younger, non–English-speaking patients, patients determined by the investigators as being unlikely

Results

One hundred forty-five male patients and 58 female patients with a mean ISS of 20 (range, 1 to 59) had a mean of 5.4 rib fractures (range, 1 to 29). Forty-four (22%) patients had bilateral fractures, 15 (7%) had flail chest, and 92 (45%) had 1 or more associated injuries with an OIS of 2 or more. The region of the chest wall with the most rib fractures was posterior in 50%, lateral in 26%, and anterior in 24% of patients.

Race and ethnicity included white non-Hispanic (191 patients [94%]),

Comments

Although rib fractures are notoriously painful, the natural history of rib fracture pain and disability has not been well studied.6 The expectations that most rib fracture pain resolves by 8 weeks and that rib fractures contribute little to long-term disability have never been subjected to prospective scrutiny. These unvalidated expectations have been an obstacle to the development of treatments that might be expected to improve the outcome of patients with rib fractures. With this prospective

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    Supported by a grant from the Medical Research Foundation of Oregon.

    John C. Mayberry, M.D. has disclosed consultant fees and honoraria of less than $10,000 over the past 5 years from Acute Innovations, LLC.

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