CHICAGO — The American College of Surgeons (ACS) has released new Best Practices Guidelines for the Management of Chest Wall Injuries, providing health care professionals with comprehensive, evidence-based strategies to improve care for patients with rib and significant sternal (breastbone) fractures.
Chest wall injuries, particularly rib fractures, are among the most common injuries in trauma patients and are a major contributor to trauma-related deaths. These injuries can lead to severe pain, impaired breathing, pneumonia, and longer hospital stays, with mortality rates as high as 36% in patients with flail chest. Flail chest occurs when multiple ribs are broken in multiple places, interfering with the body’s ability to breathe normally. The new guidelines address the full spectrum of care, from initial assessment and nonoperative management to indications and techniques to ensure patients are stable after trauma.
“Management of chest wall injuries has evolved dramatically, moving beyond the old paradigm of ‘they will heal on their own’ to a proactive, multidisciplinary approach that can significantly improve patient outcomes,” said Avery Nathens, MD, PhD, FACS, Medical Director of Trauma Quality Programs at the ACS. “These guidelines represent the latest evidence to help trauma teams effectively manage pain, prevent complications, and determine when surgical intervention is the best course of action.”
Key Points from the Guidelines
- Surgical Stabilization of Rib Fractures (SSRF): In patients with flail chest and respiratory failure, there is a strong recommendation for stabilizing the fractured ribs using metal plates or other surgical hardware. Guidance is also provided on relative indications for SSRF in patients with multiple displaced fractures without flail chest.
- Multimodal Pain Management: The guidelines place an emphasis on pain management techniques that do not rely on opioids, including regional anesthesia techniques like epidural analgesia, paravertebral blocks, and serratus anterior plane blocks.
- Optimal Timing for Surgery: While not always possible, SSRF is recommended within 48-72 hours of injury to reduce ventilator time, ICU and hospital length of stay, and complications such as pneumonia.
- Special Populations: Tailored recommendations for older adult trauma patients and patients who have sustained multiple traumatic injuries, including those with traumatic brain injury or pulmonary contusion.
- Postoperative and Rehabilitation Care: Best practices for managing pleural space (the space around the lungs), monitoring pulmonary function, and the critical role of patients being mobile after surgery and aggressive pulmonary hygiene through a comprehensive set of measures aimed at maintaining optimal lung health and preventing respiratory complications.
The guidelines were developed by a multidisciplinary panel of experts, including trauma surgeons, orthopaedic surgeons, thoracic surgeons, anesthesiologists, and allied health professionals with the publication endorsed by the Chest Wall Injury Society (CWIS) and the Orthopaedic Trauma Association (OTA).
“These guidelines provide crucial insights into the operative and nonoperative management of these painful injuries, including older patients who are particularly vulnerable to complications,” said Dr. Nathens. “This comprehensive resource will help standardize care and ensure all patients receive the highest quality care.”
The Best Practices Guidelines for the Management of Chest Wall Injuries are now available on the ACS website.
