{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T07:06:13Z","timestamp":1778569573544,"version":"3.51.4"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2021,2,6]],"date-time":"2021-02-06T00:00:00Z","timestamp":1612569600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,2,6]],"date-time":"2021-02-06T00:00:00Z","timestamp":1612569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The objective of this systematic review is to compare the safety and efficacy of surgical fixation of rib fractures against non-surgical interventions for the treatment of flail chest in the adult population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A search was performed on the 22nd of July 2020 to identify articles comparing surgical fixation versus clinical management for flail chest in adults, with a description of the outcome parameters (resource utility, mortality, adverse effects of the intervention and adverse progression in pulmonary status). Relevant randomised controlled trials were selected, their risk of bias assessed, and the data then extracted and analysed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>157 patients were included from four studies in the analyses, with 79 and 78 patients in the surgical and non-surgical groups, respectively. The pooled effects of all outcomes tended towards favouring surgical intervention. Surgical intervention was associated with lower rates of pneumonia (<jats:italic>I<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>\u2009=\u200946%,<jats:italic>Tau<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>\u2009=\u20090.16,<jats:italic>p<\/jats:italic>\u2009=\u20090.16), significantly lower rates of tracheostomy (<jats:italic>I<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>\u2009=\u200976%,<jats:italic>Tau<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>\u2009=\u20090.67,<jats:italic>p<\/jats:italic>\u2009=\u20090.02), and a significantly lower duration of mechanical ventilation (<jats:italic>I<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>\u2009=\u200988%,<jats:italic>Tau<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>\u2009=\u200933.7,<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) in comparison to the non-surgical management methods.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our results suggest that surgical intervention reduces the need for tracheostomy, reduces the time spent in the intensive care unit following a traumatic flail chest injury and could reduce the risk of acquiring pneumonia after such an event. There is a need for further well-designed studies with sufficient sample sizes to confirm the results of this study and also detect other possible effects of surgical intervention in the treatment of traumatic flail chest in adults.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00068-021-01606-2","type":"journal-article","created":{"date-parts":[[2021,2,9]],"date-time":"2021-02-09T01:36:13Z","timestamp":1612834573000},"page":"1025-1034","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Safety and effectiveness of surgical fixation versus non-surgical methods for the treatment of flail chest in adult populations: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9036-9295","authenticated-orcid":false,"given":"Ayobobola A.","family":"Apampa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayesha","family":"Ali","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryar","family":"Kadir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6267-6442","authenticated-orcid":false,"given":"Zubair","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,2,6]]},"reference":[{"issue":"2","key":"1606_CR1","doi-asserted-by":"publisher","first-page":"e143","DOI":"10.1016\/j.athoracsur.2016.07.061","volume":"103","author":"K Ten Duis","year":"2017","unstructured":"Ten Duis K, IJpma FF. Surgical treatment of snapping scapula syndrome due to malunion of rib fractures. Ann Thorac Surg. 2017;103(2):e143\u20134.","journal-title":"Ann Thorac Surg."},{"issue":"4","key":"1606_CR2","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1016\/S0039-6109(16)42194-8","volume":"60","author":"KW Jones","year":"1980","unstructured":"Jones KW. Thoracic trauma. Surg Clin North Am. 1980;60(4):957\u201381.","journal-title":"Surg Clin North Am"},{"issue":"4","key":"1606_CR3","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1016\/j.surg.2005.07.022","volume":"138","author":"BT Flagel","year":"2005","unstructured":"Flagel BT, Luchette FA, Reed RL, Esposito TJ, Davis KA, Santaniello JM, et al. Half-a-dozen ribs: the breakpoint for mortality. Surgery. 2005;138(4):717\u201323 (discussion 23\u20135).","journal-title":"Surgery."},{"issue":"4","key":"1606_CR4","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1016\/S0003-4975(10)64034-9","volume":"19","author":"JK Trinkle","year":"1975","unstructured":"Trinkle JK, Richardson JD, Franz JL, Grover FL, Arom KV, Holmstrom FM. Management of flail chest without mechanical ventilation. Ann Thorac Surg. 1975;19(4):355\u201363.","journal-title":"Ann Thorac Surg"},{"issue":"3","key":"1606_CR5","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1016\/S0003-4975(10)66339-4","volume":"5","author":"PC Adkins","year":"1968","unstructured":"Adkins PC, Groff DB, Blades B. Experiences with metal struts for chest wall stabilization. Ann Thorac Surg. 1968;5(3):246\u201354.","journal-title":"Ann Thorac Surg"},{"issue":"4","key":"1606_CR6","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1016\/S0022-5223(19)40291-2","volume":"70","author":"BP Moore","year":"1975","unstructured":"Moore BP. Operative stabilization of nonpenetrating chest injuries. J Thorac Cardiovasc Surg. 1975;70(4):619\u201330.","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"5","key":"1606_CR7","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1136\/thx.30.5.521","volume":"30","author":"F Par\u00eds","year":"1975","unstructured":"Par\u00eds F, Tarazona V, Blasco E, Cant\u00f3 A, Casillas M, Pastor J, et al. Surgical stabilization of traumatic flail chest. Thorax. 1975;30(5):521\u20137.","journal-title":"Thorax"},{"issue":"6","key":"1606_CR8","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1016\/S0022-5223(19)39590-X","volume":"75","author":"AN Thomas","year":"1978","unstructured":"Thomas AN, Blaisdell FW, Lewis FR, Schlobohm RM. Operative stabilization for flail chest after blunt trauma. J Thorac Cardiovasc Surg. 1978;75(6):793\u2013801.","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"1","key":"1606_CR9","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/S0020-1383(82)80008-9","volume":"14","author":"KP Schmit-Neuerburg","year":"1982","unstructured":"Schmit-Neuerburg KP, Weiss H, Labitzke R. Indication for thoracotomy and chest wall stabilization. Injury. 1982;14(1):26\u201334.","journal-title":"Injury"},{"issue":"Suppl 1","key":"1606_CR10","first-page":"334","volume":"59","author":"R Judet","year":"1973","unstructured":"Judet R. Costal osteosynthesis. Rev Chir Orthop Reparatrice Appar Mot. 1973;59(Suppl 1):334\u20135.","journal-title":"Rev Chir Orthop Reparatrice Appar Mot"},{"issue":"4","key":"1606_CR11","first-page":"727","volume":"52","author":"H Tanaka","year":"2002","unstructured":"Tanaka H, Yukioka T, Yamaguti Y, Shimizu S, Goto H, Matsuda H, et al. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma. 2002;52(4):727\u201332.","journal-title":"J Trauma"},{"issue":"5","key":"1606_CR12","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1016\/j.jamcollsurg.2012.12.024","volume":"216","author":"SF Marasco","year":"2013","unstructured":"Marasco SF, Davies AR, Cooper J, Varma D, Bennett V, Nevill R, et al. Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg. 2013;216(5):924\u201332.","journal-title":"J Am Coll Surg"},{"key":"1606_CR13","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.jss.2019.04.005","volume":"242","author":"T Liu","year":"2019","unstructured":"Liu T, Liu P, Chen J, Xie J, Yang F, Liao Y. A Randomized controlled trial of surgical rib fixation in polytrauma patients with flail chest. J Surg Res. 2019;242:223\u201330.","journal-title":"J Surg Res"},{"key":"1606_CR14","unstructured":"Malhotra A.K.M. Flail chest - rib fixation study (NCT01147471) ClinicalTrials.gov: ClinicalTrials.gov; 2015 [The purpose of this study is to determine whether operative fixation of unilateral flail chest provides greater benefit than non-operative treatment.]. Available from: https:\/\/clinicaltrials.gov\/ct2\/show\/NCT01147471."},{"issue":"4","key":"1606_CR15","doi-asserted-by":"crossref","first-page":"303","DOI":"10.55095\/achot2015\/047","volume":"82","author":"F Vyhn\u00e1nek","year":"2015","unstructured":"Vyhn\u00e1nek F, Jirava D, O\u010dadl\u00edk M, \u0160krabalov\u00e1 D. Surgical stabilisation of flail chest injury: indications, technique and results. Acta Chir Orthop Traumatol Cech. 2015;82(4):303\u20137.","journal-title":"Acta Chir Orthop Traumatol Cech"},{"issue":"Suppl 1 Pt 2","key":"1606_CR16","first-page":"205","volume":"50","author":"DV Karev","year":"1997","unstructured":"Karev DV. Operative management of the flail chest. Wiad Lek. 1997;50(Suppl 1 Pt 2):205\u20138.","journal-title":"Wiad Lek"},{"issue":"8\u20139","key":"1606_CR17","first-page":"499","volume":"118","author":"M Kim","year":"1981","unstructured":"Kim M, Brutus P, Christides C, Dany F, Paris H, Gastinne H, et al. Compared results of flail chests treatments: standard internal pneumatic stabilization, new technics of assisted ventilation, osteosynthesis (author\u2019s transl). J Chir (Paris). 1981;118(8\u20139):499\u2013503.","journal-title":"J Chir (Paris)"},{"issue":"4","key":"1606_CR18","first-page":"241","volume":"71","author":"J Borrelly","year":"1985","unstructured":"Borrelly J, Grosdidier G, Wack B. Surgical treatment of flail chest by sliding staples. Rev Chir Orthop Reparatrice Appar Mot. 1985;71(4):241\u201350.","journal-title":"Rev Chir Orthop Reparatrice Appar Mot"},{"issue":"6","key":"1606_CR19","doi-asserted-by":"publisher","first-page":"1676","DOI":"10.1016\/S0022-5223(95)70030-7","volume":"110","author":"Z Ahmed","year":"1995","unstructured":"Ahmed Z, Mohyuddin Z. Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation. J Thorac Cardiovasc Surg. 1995;110(6):1676\u201380.","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"1","key":"1606_CR20","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1177\/021849230401200104","volume":"12","author":"AE Balci","year":"2004","unstructured":"Balci AE, Eren S, Cakir O, Eren MN. Open fixation in flail chest: review of 64 patients. Asian Cardiovasc Thorac Ann. 2004;12(1):11\u20135.","journal-title":"Asian Cardiovasc Thorac Ann"},{"key":"1606_CR21","first-page":"1495","volume":"29","author":"JP Teng","year":"2009","unstructured":"Teng JP, Cheng YG, Ni D, Pan RH, Cheng YS, Zhu ZJ, et al. Outcomes of traumatic flail chest treated by operative fixation versus conservative approach. J Shanghai Jiaotong Univ (Med Sci). 2009;29:1495\u20138.","journal-title":"J Shanghai Jiaotong Univ (Med Sci)"},{"issue":"2","key":"1606_CR22","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1016\/j.jamcollsurg.2012.10.010","volume":"216","author":"GP Slobogean","year":"2013","unstructured":"Slobogean GP, MacPherson CA, Sun T, Pelletier ME, Hameed SM. Surgical fixation versus nonoperative management of flail chest: a meta-analysis. J Am Coll Surg. 2013;216(2):302-11.e1.","journal-title":"J Am Coll Surg"},{"issue":"6","key":"1606_CR23","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1097\/SLA.0b013e3182895bb0","volume":"258","author":"JA Leinicke","year":"2013","unstructured":"Leinicke JA, Elmore L, Freeman BD, Colditz GA. Operative management of rib fractures in the setting of flail chest: a systematic review and meta-analysis. Ann Surg. 2013;258(6):914\u201321.","journal-title":"Ann Surg"},{"issue":"2","key":"1606_CR24","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1007\/s00068-016-0721-2","volume":"43","author":"J Schuurmans","year":"2017","unstructured":"Schuurmans J, Goslings JC, Schepers T. Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review. Eur J Trauma Emerg Surg. 2017;43(2):163\u20138.","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"4","key":"1606_CR25","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1007\/s00068-018-1020-x","volume":"45","author":"RB Beks","year":"2019","unstructured":"Beks RB, Peek J, de Jong MB, Wessem KJP, Oner CF, Hietbrink F, et al. Fixation of flail chest or multiple rib fractures: current evidence and how to proceed. A systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2019;45(4):631\u201344.","journal-title":"Eur J Trauma Emerg Surg"}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-021-01606-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-021-01606-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-021-01606-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,20]],"date-time":"2023-10-20T18:51:14Z","timestamp":1697827874000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00068-021-01606-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,6]]},"references-count":25,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022,4]]}},"alternative-id":["1606"],"URL":"https:\/\/doi.org\/10.1007\/s00068-021-01606-2","relation":{},"ISSN":["1863-9933","1863-9941"],"issn-type":[{"value":"1863-9933","type":"print"},{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,6]]},"assertion":[{"value":"9 September 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 January 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 February 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"No ethics approval was needed because this is a systematic review of prospective RCTs. No personal, confidential, or sensitive material was collected from the participants in this study. All data used are already in the public domain.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"There was no need to gain any consent from participants in this review. All participants would have given their consent to be included in the original studies that this review contains, and all the data are now in the public domain.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}