Does the treatment modality affect nosocomial pneumonia and other in-hospital outcomes in patients with combined injuries to the ribs and clavicle? A propensity score weighted analysis of a retrospective cohort

Objective: What is the effect of surgical or conservative treatment on the in-hospital outcomes of patients with combined fractures of the clavicle and ribs? Design: Retrospective cohort study. Setting: Two level-1 trauma centers and academic teaching hospitals in Boston, Massachusetts. Patients: All adult patients with a clavicle fracture and ≥3 rib fractures admitted from 2016 to 2021. Intervention: None. Main outcome measurements: Nosocomial pneumonia, hospital length-of-stay (HLOS), ICU length-of-stay (ILOS), days on mechanical ventilation (DMV). Results: 252 patients were included (212 conservative, 40 surgical; median age 62 years, 67% male). The median ISS and GCS scores were 17 and 15, respectively. Thirty-seven patients developed nosocomial pneumonia. For clavicle fixation (n = 26), the OR for pneumonia was 0.3 (95% CI 0.0–2.2), ILOS had a ß-coefficient of −2.6 (95% CI −5.9–0.8), and DMV a ß-coefficient of −3.6 (95% CI −12.0–4.8). For rib plating (n = 10), the OR for pneumonia was 1.4 (95% CI 0.2–8.6), HLOS had a ß-coefficient of 4.9 (95% CI −1.6–11.5), and ILOS a ß-coefficient of 4.1 (95% CI −0.4–8.6). For both surgeries (n = 4), the CIs were wide. Conclusion: Clavicle fixation in patients with combined injuries of the clavicle and ribs did not improve nor worsen in-hospital outcomes; the orthopedic surgeon should make a patient-tailored treatment decision. Rib plating did not improve in-hospital outcomes in non-flail patients with a concomitant clavicle fracture. Guidelines on non-flail rib plating could profit from these findings in combination with previous and additional research. Level of evidence: Level III, Therapeutic Study.