Purpose: Rib fractures are the most common chest injury, occurring in approximately 300,000 individuals each year. Rib fractures normally heal between 6 weeks and 3 months postinjury without symptoms. However, nonunion will occur in 5% to 10% of patients with a rib fracture, causing persistent pain, comminuted fracture patterns, or substantially displaced fractures, all of which are indications for surgical management. This pain often may result in dyspnea or hypopnea, which may cause atelectasis or pneumonia. Nonunions may results from a soft-tissue injury, comminuted fragments, excessive displacement, smoking, NSAIDs, steroid use, hypothyroidism, or other patient factors. Surgical management may or may not include the use of a special rib plate. This video demonstrates rib plating which, which is associated with statistically significant advantages compared with nonplating. This video demonstrates revision of multiple rib nonunions via plating and bone grafting.

Methods: This video discusses the case presentation of a 50-year-old man with multiple rib fractures, pain, and clicking sensations after landing on a hard object 4 months ago. On physical examination, the patient had tenderness to palpation over ribs 8 through 11, with palpable motion noted at the fracture sites. Radiographs confirmed fractures in ribs 8 through 11 and nonunions at ribs 9 through 11. The video demonstrates revision of multiple rib nonunions via plating and iliac crest bone grafting.

Results: Postoperative radiographs confirmed proper alignment of hardware on the ribs. The patient was instructed to practice gentle range of motion of the shoulder and arm with the use of a sling for the first 2 weeks postoperatively. The patient showed continued improvement. At 3 months postoperatively, the patient was asymptomatic and had resumed normal activities without pain, and imaging studies demonstrated bony healing.

Conclusion: Although rib nonunions are uncommon, they result in great discomfort and labored breathing and require surgical management. In a prospective study on the resection of rib nonunions with or without plating, surgical fixation via plating resulted in statistically significant subjective improvements in chronic pain and activity tolerance. Plate fixation of rib nonunions may be beneficial in select symptomatic patients. Complications of plate fixation include pleural puncture, chest wall herniation, and wound infection.