Multiple rib fractures: epidemiology, management, and outcomes

The aim of this thesis was to provide insight into the epidemiology, management, andoutcomes of patients with one or more rib fractures. These aspects were evaluated through a multidimensional approach, performing national database studies, meta-analyses, multicenter clinical trials, and biomechanical research. This thesis indicates that rib fractures are common and a significant health and economic burden in the individual patient and on a nationwide scale. In the acute setting, rib fractures are associated with lengthy hospitalization and high direct costs. In the long-term, rib fractures are associated with extensive work absence and high associated indirect costs as well as a high prevalence of subjective complaints. This signifies that sustaining even one or two rib fractures significantly impacts the patient’s long-term health. In addition, this thesis also specifically addresses the impact of both rib fractures and its management, nonoperative and operative through surgical stabilization of rib fractures, in subgroups of patients. This includes patients aged >50 years, with diminished bone mineral density, following cardiopulmonary resuscitation, and with traumatic brain injury. These studies have been the result of (inter)national collaborations with experts within the field of chest wall injury management. To answer the question which treatment is best for multiple rib fractures, the Trauma Research Unit of the Department of Surgery at the Erasmus Medical Center has designed a multicenter randomized controlled trial. This trial, of which the protocol is published in this thesis, is currently being conducted and, amongst others, being coordinated by Jonne Prins.