We need a common definition and treatment algorithm for displaced rib fracture

Background: Displaced rib fracture (DRF) definition is frequently used to draw attention to severity and importance of fracture in daily practice. DRF is associated with increased morbidity and mortality in addition patients with DRF should be followed more carefully. Despite these characteristics, we do not have a clear definition for DRF concept and big differences of opinion among physicians could be monitored. In this study, we tried to reveal these perceptual differences and emphasized the importance of creating a common language for DRF. Materials and Methods: We used a special and inventive survey form which contains visual section, true-false section and case reports. In the visual section, real tomography images and schematic drawings were presented to participants and asked which were compatible with DRF. In the true-false section, propositions about the definition of DRF were presented. Finally, imaginary trauma cases were presented and the minimum follow-up period was questioned. Results: 156 physicians from 23 different center were included in the study. Of the participants, 56 (35.9%) were emergency physicians, 54 (34.6%) were thoracic surgeons and 46 (29.5%) were radiologists. The answers were statistically different for 3 tomography image (p = 0.056, p < 0.001, p = 0.001) and for 1 schematic drawings (p = 0.001). Again in 4 of the 7 true-false questions, there were significant differences between answers (p = 0.001, p = 0.001, p = 0.005, p < 0.001). The minimum follow-up period for a patient with DRF was also different between physicians, and have been recommended as 15.9 ± 2.2 (2-72 hours) by emergency physicians, 27.3 ± 5.5 (2-120) by radiologist and 31.5 ± 3.1 (2-120) by thoracic surgeons. Conclusions: Our study clearly demonstrates a big conflict about DRF defination and treatment among physicians. There is also no consensus on the minimum follow-up time. We believe that our study will be a guide for multidisciplinary clinical studies on this subject.