Epidemiology of Symptomatic Non-Union/Malunion Rib Fractures

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Abstract
Background: Some rib fractures do not heal appropriately and can cause significant pain and morbidity. Little is known about the locations likely to experience dysfunctional healing. We sought to determine the location of symptomatic non-union/malunion (NU/MU) rib fractures presenting to our Chest Wall Injury and Reconstruction Center. Methods: A single-center retrospective cohort study was conducted on all patients with NU/MU fractures presenting for evaluation at our CWIRC from 1 January 2019 to 30 July 2023. Their rib injury locations were mapped using computed tomography scans of the chest and a physical exam was used to characterize the location of their symptomatic NU/MU fractures. The location of the NU/MU injury was identified as either the anterior (A), anterior–lateral (AL), lateral (L), posterior–lateral (PL), or posterior (P) region of the chest wall. The results are presented as a mean +/− standard deviation for normally distributed data and median (minimum—maximum) for non-normally distributed data. Results: A total of 28 cases were evaluated. The average age at time of presentation was 48+/−14 years and 71% of patients were male. A total of 72 NU/MU fractures (median/pt 2(1–11)) were evaluated. Sixty-one percent of the injuries were on the right side. In most patients (25/28, 89%), the injuries were all in the same anatomic location in the rib cage. Three patients had NU/MU injuries in multiple anatomic locations. All multilevel injuries were sequential, without any normally healed ribs between NU/MU injuries. The most common locations were the L and PL regions (A–3, AL–8, L–19, PL–42, P–0). The most commonly symptomatic ribs were in ribs 6–10. Conclusions: Symptomatic NU/MU healing often occurs in the L and PL locations along the bony chest wall. Symptomatic NU/MU injuries also occur in the cartilaginous extensions of the bony ribs and along the costal margin. Symptomatic NU/MU healing is uncommon in the A and AL upper rib cage, as well as in P injuries.

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