• Kenichiro Uchida, Masahiro Miyashita, Shinichiro Kaga, Tomohiro Noda, Tetsuro Nishimura, Hiromasa Yamamoto, and Yasumitsu Mizobata.
• Department of Traumatology and Critical Care Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
• Trauma Surg Acute Care Open. 2020 Jan 1; 5 (1): e000546.

BackgroundRecently, interest has increased in surgical fixation for severe thoracic wall injury with good short-term outcomes. However, few reports have evaluated long-term outcomes or complications. This study aimed to assess long-term quality of life and implant-related complications after rib fixation for flail chest and multiple rib fractures.MethodsWe interviewed patients who had undergone rib fixation from January 2014 to December 2019 about their current ability to work and their usual life.ResultsTwenty-two patients underwent rib fixation during the study period. Two patients with flail chest had already died after the surgery due to senescence; thus, follow-up information was obtained from 20 patients (91%), with a follow-up duration of 47.5 (IQR 22-58) months. The most undesirable event occurring during the study period was irritation caused by a palpable plate (n=2, 10%), probably due to the thin skin of patients over 70 years old. Eighteen patients were able to return to their usual life or same work as in the premorbid state with no complaints. Two patients are still undergoing rehabilitation due to concomitant extremities fractures. The median EQ-5D-5L index score was 0.89 (IQR 0.84-0.93). There were no implant-related complications requiring plate explantation.DiscussionWe concluded that rib fixation offers good long-term benefits, with the ability of the patient with flail chest or multiple rib fractures to return to activity in the premorbid state. Elderly patients especially with thin, soft tissue may complain of irritation caused by the plate and should be informed of this prior to surgery.Level Of EvidenceLevel IV therapeutic care/management.© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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