UF Health trauma surgeon, other experts call for new standard in fractured ribs treatment

Lawrence Lottenberg, M.D., associate professor of surgery and anesthesiology at UF’s College of MedicineFor most patients in the United States with several broken ribs, recovery is a months long journey full of immense pain, difficulty breathing and a high risk of serious complications.

But according to a new report from a group of surgeons from across the country — including a University of Florida Health trauma surgeon — a technique called surgical rib fixation, or rib plating, shortens recovery time, decreases the risk of complications and can reduce pain by as much as 80 percent in patients. The report, published online in the September  issue of General Surgery News, aims to increase the use of rib plating in patients with multiple rib fractures at medical centers across the country.

In June, UF Health’s Lawrence Lottenberg, M.D., associate professor of surgery and anesthesiology at UF’s College of Medicine,  joined surgeons from across the nation at a consensus meeting about rib fractures. The rib plating procedure involves attaching flexible metal bars to the broken bones to stabilize them and help them heal correctly.

“I think that most of the experts doing rib plating believe that this is a standard of care right now,” Lottenberg said. “That’s the ultimate goal.”

Although surgeons at many medical centers have adopted the practice, most hospitals in the United States still do not offer rib plating, or offer it only in extreme cases, the group’s report states. That means every year thousands of people who would benefit from the procedure remain needlessly in a prolonged, dangerous and extremely painful state. Lottenberg said the procedure’s complex nature and limited existing research on the subject likely explain its lack of popularity nationwide.

The current standard of care in the U.S. for patients with multiple broken ribs focuses on pain management through medication. The new report outlines guidelines for when and how rib plating should be done, as agreed upon at the consensus meeting, and also describes the procedure’s extensive benefits.

These benefits include allowing patients to breathe on their own more easily — enabling them to be free of a ventilator sooner than they otherwise would — and drastically reducing their pain. Lottenberg estimated the procedure cuts pain by about 80 percent for patients with the highest levels of pain from their broken ribs. It also decreases their chances of developing complications and significantly shortens recovery time.

UF Health’s trauma surgeons have been plating ribs for about four years, and some UF Health thoracic and cardiovascular surgeons also perform the procedure. The trauma team has plated ribs in about 100 patients, Lottenberg said.

 “If you have three or more fractured ribs and they’re displaced and the patient cannot generate enough force to breathe on their own safely without getting pneumonia or collapse of their lungs, we plate these patients,” he said. “We have an algorithm that we follow.”

Proper care of patients who undergo rib plating also includes complementary therapies after surgery.

“It’s not only the plating that makes a difference in the outcome, it’s also to have anesthesia, provide pain catheters, provide good pulmonary care to the patient and encourage them to breathe deeply and things like that,” Lottenberg said. “It’s a whole process.”

Media Contact: Katrina Ciccarelli 352-265-0373 or email: kciccarelli@ufl.edu