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Table 1 Eligibility criteria

From: Effectiveness of rib fixation compared to pain medication alone on pain control in patients with uncomplicated rib fractures: study protocol of a pragmatic multicenter randomized controlled trial—the PAROS study (Pain After Rib OSteosynthesis)

Inclusion criteria

Exclusion criteria

• At least 2 rib fractures

• At least 1 dislocated rib fracture

• Fractures accessible to surgery

• Thoracic trauma no more than 2 days prior to screening for inclusion

• Thoracic epidural analgesia

• Written informed consent

• Any other concomitant fractures excepted clavicle fracture

• Respiratory distress syndrome according to the Berlin definition [14]

• Presence of >1.5 l of blood drained from the pleural space

• Hemostasis disorder defined by any of the following criteria:

- Platelet count < 70,000/mm3,

- International normalized ratio (INR) > 1.2 (prothrombin < 70%)

- activated partial thromboplastin time (aPTT) ≥ 60 s

- drugs such as: P2Y12 antagonists (clopidogrel, prasugrel) and glycoprotein IIb/IIIa antagonists (abciximab, tirofiban)

• Pathological rib fracture due to metastasis

• Hemodynamic instability: systolic blood pressure < 100 mmHg and heart rate > 100 beats per minute

• Neurologic disorder: Glasgow Coma Score < 13 in the initial 24 h, or intracerebral, epidural, subdural, or subarachnoid hemorrhages, or cerebral contusion

• Titanium allergy

• Known or suspected non-compliance to medical therapy due to drug or alcohol abuse

• Age <18 years old

• Women known to be pregnant or breast feeding thus contraindicating surgery

• Inability to follow the procedures of the study, e.g., due to language problems, psychological disorders, dementia, etc.