A novel surgical approach to the management of rib fractures, Surgical Stabilization of Rib Fractures (SSRF), was successfully performed for the first time in Pune, at KEM Hospital Under the guidance and management of Dr. Vinod Naik and Dr. Akhil Hazari from the Department of General Surgery.

On 24th May 2025 the team of surgeons operated on a 61-year-old male patient who was admitted in KEM Hospital after sustaining extensive thoracic and facial injuries following a road traffic accident. He was admitted with multiple bilateral rib fractures with flail segments. As a result of these injuries the patient required mechanical ventilation for respiratory support due to compromised chest wall mechanics.

In this landmark case the team of Dr. Hazari and Dr. Naik utilized the MatrixRIBTM Fixation System by Johnson & Johnson to perform the bilateral rib fixation. The surgery was successful and there was immediate improvement in the patient’s ventilation, and he was able to be weaned off the ventilator soon after the procedure.

Rib fractures are among the most common injuries resulting from thoracic trauma and have always been a cumbersome problem to manage. These patients carry an increased risk of morbidity and mortality which correlates to the presence of multiple rib fractures, flail chest, as well as intrathoracic injuries. These injuries are complicated by associated underlying lung injury, respiratory compromise, atelectasis, and accumulation of secretions resulting in respiratory failure. In the long-term rib fractures can lead to chronic pain, functional impairment disability, and reduced quality of life.

Traditionally, standard protocols for management of rib fractures have long been non-operative and have included adequate analgesia for pain management, chest physiotherapy, pleural drainage, and in severe cases, intubation with mechanical ventilation. However, in cases involving more than three displaced rib fractures or oblique flail segments, prolonged mechanical ventilation and ICU admission leads to increased rates of pneumonia, sepsis, barotrauma, and a need for tracheostomy. Moreover, it can lead to an increase in utilization of healthcare resources, whilst placing a significant financial burden on patients and hospitals.Surgical fixation of rib fractures have been performed sporadically for nearly 100 years. However, it has only been in recent years, with the advent of newer materials and technologies, that data surrounding SSRF and its benefits has increased drastically. As a result, SSRF has become a more widely accepted evidence-based treatment option. Using this new data, the World Society of Emergency Surgery (WSES) and Chest Wall.

Injury Society (CWIS) have outlined guidelines for the use of SSRF, which include:

• All patients with flail segments
• ≥3 displaced rib fractures
• Chest wall deformities severely affecting lung function
• Multiple rib fractures with persistent respiratory failure despite mechanical ventilation or weaning failure.
• Severe pain, non-responsive to other treatments.

Despite the development of newer protocols and guidelines, as well as strong evidence supporting SSRF, operative fixation of rib fractures remains under-utilized as a modality of treatment. With this first successful case, the Department of General Surgery at KEM Hospital is proud to lead the way in Pune by offering SSRF as a treatment option. With this step forward we hope to raise awareness amongst our colleagues in the medical community about the benefits of surgical rib fixation, and we hope to help more patients with this novel approach.