Ryder Trauma Center Surgical Stabilization of Rib Fractures (SSRF)

The primary trauma team is responsible for initial evaluation of patient candidacy for SSRF.  Patients should be referred for possible SSRF if they meet any of the following criteria:

• Flail chest (clinical or radiographic)
• ≥3 displaced rib fractures with significant pain or respiratory compromise
• Failure of optimal multimodal pain control
• Inability to wean from mechanical ventilation attributable to chest wall instability
• Progressive pulmonary decline (e.g., worsening incentive spirometry, increasing oxygen requirement)
• Chest wall deformity or significant displacement noted on CT imaging
• Concomitant thoracic injuries requiring operative intervention
• Primary trauma attending discretion

Early consultation (within 24h of presentation) is encouraged when any of the above criteria are met. For all referrals, please place order 3D reconstruction of the chest CT and request that radiology techs process the order immediately.

The SSRF Surgeon of the Week evaluates referrals from the primary trauma team.  The SSRF Surgeon of the Week is listed as a separate column in the monthly attending schedule.

Responsibilities include:

• Coordinating evaluation and imaging review
• Determining operative candidacy and brief documentation
• Ensuring continuity of care and appropriate workup and operative scheduling
• Entering consult into REDCap QI database

Patients presenting to Jackson South who meet SSRF referral criteria should be discussed immediately with the SSRF Surgeon of the Week and considered for early transfer to Ryder Trauma Center/JMH for optimal access to interventional pain control, critical care including ECMO, and SSRF if indicated. The decision to transfer the patient is patient-specific and based on primary trauma attending discretion with special consideration given to the patient’s burden of injuries and co-morbidities.

Sermonesi G, Bertelli R, Pieracci FM, Balogh ZJ, Coimbra R, Galante JM, Hecker A, Weber D, Bauman ZM, Kartiko S, Patel B, Whitbeck SS, White TW, Harrell KN, Perrina D, Rampini A, Tian B, Amico F, Beka SG, Bonavina L, Ceresoli M, Cobianchi L, Coccolini F, Cui Y, Dal Mas F, De Simone B, Di Carlo I, Di Saverio S, Dogjani A, Fette A, Fraga GP, Gomes CA, Khan JS, Kirkpatrick AW, Kruger VF, Leppäniemi A, Litvin A, Mingoli A, Navarro DC, Passera E, Pisano M, Podda M, Russo E, Sakakushev B, Santonastaso D, Sartelli M, Shelat VG, Tan E, Wani I, Abu-Zidan FM, Biffl WL, Civil I, Latifi R, Marzi I, Picetti E, Pikoulis M, Agnoletti V, Bravi F, Vallicelli C, Ansaloni L, Moore EE, Catena F. Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper. World J Emerg Surg. 2024 Oct 18;19(1):33. doi: 10.1186/s13017-024-00559-2. Erratum in: World J Emerg Surg. 2025 Jan 29;20(1):8. doi: 10.1186/s13017-024-00568-1. PMID: 39425134; PMCID: PMC11487890.

American College of Surgeons. (2025). Best Practices Guidelines for the Management of Chest Wall Injuries. https://www.facs.org/media/qdgliayt/2025_tr_bestpracticesguidelines_chest-wall.pdf.

Bauman ZM, Tian Y, Doben AR, Schubl SD, Pieracci FM, Kaye AJ, Towe CW, Patel B, Kartiko S, Whitbeck SA, Sarani B, White TW. Chest Wall Injury Society guidelines for surgical stabilization of rib fractures: Indications, contraindications, and timing. J Trauma Acute Care Surg. 2025 Oct 1;99(4):522-532. doi: 10.1097/TA.0000000000004750. Epub 2025 Aug 13. PMID: 40802491; PMCID: PMC12893141.