• Felix Peuker, Roelien A Haveman, Roderick M Houwert, Thomas P Bosch, Ruben J Hoepelman, Fabrizio Minervini, Frank J P Beeres, van de WallBryan J MBJMDepartment of Orthopedic and Trauma Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland.Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland., and NEXT study group.
• Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. felix.peuker@luks.ch.
• Eur J Trauma Emerg Surg. 2025 Jan 24; 51 (1): 7676.

PurposeLittle is known about the prevalence, impact and change of the symptoms after implant removal due to irritation in multiple rib fractures. This study aims to explore these aspects to improve treatment decision-making.MethodsData was collected from two hospitals in the Netherlands and Switzerland. The study included only adults with operatively treated multiple rib fractures, regardless of whether the fractures were flail or non-flail. The primary outcome was the incidence of implant removal due to irritation. Secondary outcomes included implant irritation not leading to removal, other postoperative complications, and remission rates after implant removal. These outcomes were assessed during a follow-up phone call using a standardized questionnaire.ResultsHundred-twenty patients were identified, with 83 (69.2%) completing the final follow-up after a median of 49 months (IQR 40-59). Twenty-five (30.1%) patients experienced implant irritation, of whom four (4.8%) got their implant removed. Two (2.4%) reported significant improvement, one (1.2%) moderate, and one (1.2%) no improvement of symptoms.ConclusionImplant irritation in patients with multiple rib fractures is a common problem, even years after surgery, without guaranteed symptom improvement post-removal. These results provide an additional argument to be more selective in offering rib fixation to patients with multiple rib fractures in the first place.© 2025. The Author(s).

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