Risk factors affecting pulmonary complications in elderly patients with isolated rib fractures

Background: Blunt chest injuries are the predominant cause of rib fractures, which frequently result in pulmonary complications. We hypothesized that different trauma mechanisms and fracture patterns are associated with pulmonary complications in elderly patients (>= 65 years) with isolated rib fractures. Methods: We retrospectively reviewed the data of patients with rib fractures recorded in the electronic medical record system of a trauma center from 2015 to 2019. The correlation between age, comorbidities, trauma mechanisms, fracture patterns, and pulmonary complications was examined. Results: A total of 168 elderly patients with isolated rib fractures after trauma were included in the study. Except for one patient who died, all other patients recovered and were discharged. Univariate analysis identified age, trauma mechanisms, and fracture patterns as potential risk factors for pulmonary complications. Multivariate logistic regression analysis found that falls [odds ratio (OR) 5.051, 95% confidence interval (CI): 1.380-18.485; P=0.01], rib fracture displacement (OR 4.924, 95% CI: 1.826- 13.275; P=0.002), and multiple rib fractures (>= 2 ribs) (OR 2.984, 95% CI: 1.182-7.531; P=0.02) were the independent risk factors for pulmonary complications. Subgroup analysis showed that hemothorax occurred in 47 (85.5%, P=0.001) patients with falls, 69 (89.6%, P<0.001) patients with displaced rib fractures, and 99 (74.4%, P<0.001) patients with multiple rib fractures. Conclusions: The traumatic mechanisms and fracture patterns appear to be related to pulmonary complications, with patients experiencing falls, displaced rib fractures, and multiple rib fractures being more likely to develop these complications.