Rib plating, or surgical stabilization of rib fractures, is a procedure designed to repair and stabilize broken ribs following severe chest wall trauma. This technique involves internally fixing the fractured bones with specialized hardware. It is reserved for patients with displaced or multiple rib breaks that compromise breathing mechanics and cause severe pain. Stabilization promotes proper healing and helps prevent serious respiratory complications associated with these injuries.
Understanding Severe Rib Injuries and Flail Chest
Most single or non-displaced rib fractures heal successfully with non-operative treatment, relying on pain management while the bone naturally knits together. However, severe rib injuries require surgical intervention when fractures are numerous or severely displaced. These injuries often result from high-impact blunt trauma, such as car accidents or major falls.
The clearest indication for rib plating is flail chest. This occurs when three or more adjacent ribs are broken in at least two places each, creating a segment of the chest wall detached from the rest of the rib cage. This segment moves paradoxically—sinking in during inhalation and bulging out during exhalation—directly interfering with normal lung function and breathing.
The resulting instability leads to inadequate oxygenation and severe pain, increasing the risk of respiratory failure, pneumonia, and prolonged hospitalization. Surgical stabilization is necessary to correct this mechanical defect. Rib plating is also used for multiple displaced rib fractures that cause uncontrolled pain, poor respiratory function, or chronic pain due to non-union (failure of the bone to heal correctly).
Hardware and Surgical Steps of the Procedure
The goal of the procedure is to realign the fractured bone fragments and hold them rigidly in place for proper bone healing. The hardware is typically titanium, a lightweight, corrosion-resistant, and biocompatible material. Titanium is well-tolerated and considered safe for magnetic resonance imaging (MRI) after implantation.
The plates come in various designs, including straight, contoured, and U-shaped, engineered to fit the natural curve and unique anatomy of the ribs. Most systems use locking plates, which feature screws that lock directly into the plate. This provides a stable, fixed-angle construct independent of the patient’s bone quality, offering superior stability for the fracture site.
The surgical process begins under general anesthesia with an incision over the fractured rib segments. Advances often allow for a minimally invasive approach, using smaller incisions to reduce trauma to surrounding soft tissues. Once the fracture site is exposed, the surgeon performs a reduction, carefully realigning the broken bone pieces to their correct anatomical position.
A plate is then selected, contoured to the rib, and secured to the bone on either side of the fracture using small bicortical screws. The number of ribs fixed depends on the extent of the injury, but the aim is to stabilize the chest wall enough to eliminate the paradoxical motion.
Expected Recovery and Long-Term Outcomes
Following surgery, patients typically spend several days in the hospital, often with a period in the intensive care unit depending on the severity of the initial injury. Immediate post-operative care focuses on aggressive pain management to ensure the patient can breathe deeply and cough effectively. Pain control frequently involves epidural catheters or nerve blocks, which target the nerves around the ribs to reduce the need for systemic opioid medication.
Respiratory physical therapy begins almost immediately to encourage lung expansion and prevent complications like pneumonia. Patients are guided through breathing exercises to maximize lung capacity and clear secretions. Early stabilization allows for this aggressive physical therapy and mobilization, contributing to a faster overall recovery.
Patients experience a significant reduction in pain within weeks. The hardware is intended to be a permanent implant that supports the ribs until the bone heals, which takes several months. Long-term outcomes include improved breathing mechanics and a quicker return to normal activities compared to non-operative treatment for severe fractures. While some patients require hardware removal years later due to irritation, most tolerate the plates well and experience lasting functional improvement.