Title : Who fixes rib fractures in the UK? Insight from a national cross-sectional study
Abstract:
Background: Rib fracture fixation is increasingly recognized in managing severe thoracic trauma. While current guidelines address management, little is known about which surgical specialties perform this procedure across UK and the rationale behind it. This national survey aimed to identify the primary surgical specialty responsible for rib fixation in UK and explore their arguments for specialty suitability.
Method: A cross-sectional survey was distributed via Google Forms to rib fixation leads across Major Trauma Centres (MTCs) in 12 UK regions. The initial email was sent on 25/02/2025, followed by three biweekly reminders. The survey collected hospital names, regions, performing specialty, access to onsite thoracic services, additional procedures and opinions on which specialty should perform the operation and why.
Results: Out of 20 MTCs from 12 regions that are invited, 12 MTCS from 8 regions responded (2 in Scotland, 1 in Wales, 9 in England). Six centres (50%) reported thoracic surgery as the main specialty performing fixation, five (41.7%) for orthopaedic, and one uses both. 75% of centres have onsite thoracic services. All thoracic surgeons reported using Video-Assisted Thoracoscopy (VATS) for pleural inspection. Surgical preference varied: 5 respondents favoured orthopaedics, 4 for thoracic surgery, and 3 express no preference as depends on availability. The main arguments favour orthopaedics were expertise in muscle-sparing dissection, bone-fixation, and managing polytrauma patients. In contrast, thoracic surgeons’ ability to use VATS for identifying subtle pleural injuries which may be undetectable by CT scan was their key advantage.
Conclusion: Fixation responsibilities are evenly split between thoracic and orthopaedic specialties in surveyed MTCs. Orthopaedics are often preferred due to experience with bone-fixation and polytrauma management, though thoracic surgery offers unique benefits through VATS. Further research is needed to compare postoperative outcomes and pleural injury detection rates through VATS and its clinic.
