Age and Injury Burden, Not Frailty, Are Associated With Surgical Stabilization of Non-Flail Rib Fractures in Older Adults

We evaluated older, frail, adult patients who underwent surgical stabilization of rib fractures (SSRF) for non-flail fracture patterns with those who were treated nonoperatively (NOM). Factors were examined that may contribute to patient selection for SSRF in this population. Methods: Single-center, IRB-approved retrospective study of patients age ≥55 years treated for rib fractures at a Level 1 trauma center from January 1, 2014 to February 12, 2024. A modified 5-item frailty index (mFI-5) score of 2 or higher was used to indicate frailty. Results: Of 2,072 patients, 448 (SSRF n=29, no SSRF n = 419) met inclusion criteria (three or more rib fractures, non-flail fracture pattern, and mFI-5 score of 2 or higher). Both groups had similar frailty scores (2 vs 2, P = .053). The SSRF group was younger (67 vs 72, P < .05), had more ribs fractured (6 vs. 5, P < .05), had a higher ISS (17 vs. 13, P < .05), chest abbreviated injury score (CAIS) (3.1 vs 2.9, P < .05), RibScore (2 vs. 0, P < .05), and more severely displaced rib fractures (11 vs. 2, P < .05). Conclusions: SSRF was performed in younger patients with a higher ISS, CAIS, and RibScore. Patients receiving SSRF also had more ribs fractured and a higher number of severely displaced fractures. Future studies are needed to evaluate selection criteria for this vulnerable population and the effect of SSRF on mortality. Level of Evidence Level III: Retrospective comparative study. Keywords: frail, rib fractures, SSRF, surgical fixation.