Multiple Rib Fractures

This prospective observational cohort study will evaluate whether the Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI) can predict short-term clinical outcomes in adults aged 65 years or older with isolated blunt thoracic trauma and more than three rib fractures. Participants will be enrolled in the Emergency Department of Ankara Etlik City Hospital. No experimental drug, device, or additional invasive procedure will be used. Routine clinical, laboratory, anthropometric, imaging, and follow-up data will be recorded. The study plans to include 294 participants. The primary outcome is a composite short-term poor clinical outcome, including in-hospital mortality, intensive care unit admission, invasive or non-invasive mechanical ventilation, pneumonia, atelectasis, tube thoracostomy, or hospital stay of 7 days or longer. The prognostic performances of GNRI and PNI will be compared. Secondary outcomes include the individual components of the composite outcome, new pneumothorax or hemothorax, hospital and intensive care unit length of stay, 30-day emergency department revisit, and 30-day mortality.

This prospective randomized clinical trial aims to compare the effect of continuous erector spinae plane block versus continuous edge of laminar block on the quality of analgesia and diaphragmatic excursion in patients with unilateral traumatic multiple rib fractures.

* Epidemiology \& Impact Thoracic trauma is a common and serious injury worldwide-especially in developing countries-and carries high rates of morbidity and mortality. Complications arise primarily from hypoventilation, which leads to atelectasis, pneumonia, and respiratory failure. * Key to Reducing Complications: Pain Control Effective analgesia is the cornerstone of preventing respiratory complications. Inadequate pain relief causes patients to splint and hypoventilate, setting the stage for pulmonary collapse and infection. * Conservative Management * Analgesics: Systemic pharmacological pain relief remains the mainstay. * Supportive Measures: Rest, application of ice, and encouragement of deep breathing exercises. * Incentive Spirometry: Promoted in all patients to maintain lung expansion and ward off atelectasis. * Regional Anesthesia Techniques To further improve comfort and respiratory mechanics, ultrasound-guided nerve blocks are employed according to fracture location: * Serratus Anterior Plane Block for anterolateral rib fractures * Thoracic Paravertebral Block for posterior rib fractures * Surgical Intervention Reserved for complex cases-such as flail chest or fractures with risk of organ injury-where stabilization or repair may be necessary. * Identified Gap Despite these options, thoracic surgeons currently lack a standardized, procedure-specific pain management protocol beyond systemic analgesics, highlighting a need for consensus guidelines that integrate pharmacological and regional techniques.