Non-union of rib fractures is an uncommon complication that occurs when the fracture has incompletely healed 3-6 months after injury 1,2. These can be symptomatic, causing instability with mechanical symptoms (clicking and motion), chronic pain, and dyspnea on exertion 3. The rate of non-union is estimated to be between 5-10%, but is not well studied for rib fractures 4,5. In a recent meta-analysis of patients who previously underwent acute surgical stabilization of rib fractures (SSRF), 1.3% had non-union 6. Suspected risk factors include smoking, malnourishment, NSAIDs or steroids, diabetes, and deficiency of vitamin D 4.

Historically, surgical management of symptomatic rib fracture non-union involved surgical resection of the affected ribs. Despite continued research into the indications for SSRF in severe rib fracture and flail chest, there is limited evidence investigating the management of rib fracture non-union. A few case reports and cross-sectional case series describe the operative management for symptomatic non-unions and there are no systematic or scoping reviews into the management of rib fracture non-union.

Therefore, our objective was to perform a scoping review of the management of rib fracture non-union following traumatic injuries. The key questions (KQs) guiding the conduct of this scoping review are outlined below:

KQ 1: What are the current techniques employed to manage non-union of rib fractures?

KQ 2: What is the impact of these techniques on outcomes including but not limited to radiographic union, pain reduction, complications, length of stay and return to work?