Oral and I.V. pain medications help to control pain but may depress respiratory function.  Intercostal nerve blocks provide pain relief without affecting respiratory function, Topical treatment as well as epidural catheters have also been used in the acute setting but appear to only be a short-term solution to a problem that takes weeks to months for recovery.  Epidural catheters have not altered the morbidity or mortality associated with rib fractures.In the past, surgical options for the treatment of rib fractures have required large incision and long hospital stays in the past.  We have developed a less invasive way to fix broken ribs.  Minimally Invasive Muscle Sparing (MIMS) Rib fixation is a less invasive option for surgical treatment of rib fractures.  MIMS rib fixation utilizes a video scope in the chest to reduce fractures and localize fractures.  The small incision for fixation spares the muscle fibers and thus causes less pain.  The fixation plate is then placed beneath the muscle and applied directly to the broken rib.  Most patients will describe the difference in pain before and after surgery as “Night and Day”.

Surgical fixation of rib fractures has become a more attractive treatment option  because of the immediate and long term advantages of surgery.  Patients with a flail chest, which is more than one fracture over more than one rib, have seen a reduction in days on the ventilator, days in the hospital, days in the ICU, less pain and faster return to work.

This advantage has also been seen in patients without a flail chest but multiple and sometimes single rib fractures.  Rib Fractures are often underestimated and overlooked.  Many patients die each year from rib fractures alone after a simple fall from standing.  MIMS rib fixation is a safe and effective treatment for broken ribs.

We treated a middle aged man in our hospital with four broken ribs and a collapsed lung with VATS and MIMS rib fixation (Figure 2).  He had no pain after surgery and went home in 3 days.  His surgery was performed through a 4 cm incision (fig 3).  He returned to work in 6 days after surgery.

(Figure 2) CXR after ORIF of four(4) broken ribs

(Figure 3)  4 cm MIMS incision with exposed fracture with plate 

The MIMS rib fixation procedure is a less invasive technique with less tissue disruption and less surgical trauma.  Our data shows a much faster recovery than what has been seen with other types of procedures and most patients have little to no pain after surgery.  Patients do not have to suffer with rib fractures as there are now ideal surgical treatment options as discussed in this article.