{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T08:37:37Z","timestamp":1782463057139,"version":"3.54.5"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2022,2,3]],"date-time":"2022-02-03T00:00:00Z","timestamp":1643846400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,2,3]],"date-time":"2022-02-03T00:00:00Z","timestamp":1643846400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100017590","name":"Universit\u00e4tsklinikum Essen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100017590","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>In severely injured patients with multiple rib fractures the beneficial effect of surgical stabilization is still unknown. The existing literature shows divergent results and especially the indication and the right timing of an operation are subject of a broad discussion. The aim of this study was to determine the influence of a surgical stabilization of rib fractures (SSRF) on the outcome in a multi-center database with special regard to the duration of ventilation, intensive care and overall hospital stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Data from the TraumaRegister DGU\n                      <jats:sup>\u00ae<\/jats:sup>\n                      collected between 2008 and 2017 were used to evaluate patients over 16\u00a0years with severe rib fractures (AIS\u2009\u2265\u20093). In addition to the basic comparison a matched pair analysis of 395 pairs was carried out in order to find differences and to increase comparability.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total 483 patients received an operative treatment and 29,447 were treated conservatively. SSRF was associated with a significantly lower mortality rate (7.6% vs. 3.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008) but a longer ventilation time and longer stay as well as in the intensive care unit (ICU) as the overall hospital stay. Both matched pair groups showed a good or very good neurological outcome according to the Glasgow Outcome Scale (GOS) in 4 of 5 cases. Contrary to the existing recommendations most of the patients were not operated within 48\u00a0h.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In our data set, obviously most of the patients were not treated according to the recent literature and showed a delay in the time for operative care of well over 48\u00a0h. This may lead to an increased rate of complications and a longer stay at the ICU and the hospital in general. Despite of these findings patients with operative treatment show a significant lower mortality rate.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00068-021-01864-0","type":"journal-article","created":{"date-parts":[[2022,2,3]],"date-time":"2022-02-03T12:04:56Z","timestamp":1643889896000},"page":"2773-2781","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Effect of surgical stabilization of rib fractures in polytrauma: an analysis of the TraumaRegister DGU\u00ae"],"prefix":"10.1007","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7876-2580","authenticated-orcid":false,"given":"Lars","family":"Becker","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Schulz-Drost","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Spering","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Franke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Dudda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf","family":"Lefering","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5896-9875","authenticated-orcid":false,"given":"Gerrit","family":"Matthes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0708-1259","authenticated-orcid":false,"given":"Dan","family":"Bieler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Committee on Emergency Medicine, Intensive Care, Trauma Management (Sektion NIS) of the German Trauma Society (DGU)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,2,3]]},"reference":[{"issue":"2","key":"1864_CR1","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/ta.0000000000000925","volume":"80","author":"FM Pieracci","year":"2016","unstructured":"Pieracci FM, Lin Y, Rodil M, Synder M, Herbert B, Tran DK, et al. A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures. J Trauma Acute Care Surg. 2016;80(2):187\u201394. https:\/\/doi.org\/10.1097\/ta.0000000000000925.","journal-title":"J Trauma Acute Care Surg"},{"issue":"2","key":"1864_CR2","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1097\/bot.0000000000000750","volume":"31","author":"E Swart","year":"2017","unstructured":"Swart E, Laratta J, Slobogean G, Mehta S. Operative treatment of rib fractures in flail chest injuries: a meta-analysis and cost-effectiveness analysis. J Orthop Trauma. 2017;31(2):64\u201370. https:\/\/doi.org\/10.1097\/bot.0000000000000750.","journal-title":"J Orthop Trauma"},{"issue":"3","key":"1864_CR3","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1097\/TA.0000000000001350","volume":"82","author":"G Kasotakis","year":"2017","unstructured":"Kasotakis G, Hasenboehler EA, Streib EW, Patel N, Patel MB, Alarcon L, et al. Operative fixation of rib fractures after blunt trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):618\u201326. https:\/\/doi.org\/10.1097\/TA.0000000000001350.","journal-title":"J Trauma Acute Care Surg"},{"issue":"1","key":"1864_CR4","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1007\/s00268-015-3169-3","volume":"40","author":"TP Nickerson","year":"2016","unstructured":"Nickerson TP, Thiels CA, Kim BD, Zielinski MD, Jenkins DH, Schiller HJ. Outcomes of complete versus partial surgical stabilization of flail chest. World J Surg. 2016;40(1):236\u201341. https:\/\/doi.org\/10.1007\/s00268-015-3169-3.","journal-title":"World J Surg"},{"key":"1864_CR5","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD009919.pub2","author":"AJ Cataneo","year":"2015","unstructured":"Cataneo AJ, Cataneo DC, de Oliveira FH, Arruda KA, El Dib R, de Oliveira Carvalho PE. Surgical versus nonsurgical interventions for flail chest. Cochrane Database Syst Rev. 2015. https:\/\/doi.org\/10.1002\/14651858.CD009919.pub2.","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"1864_CR6","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1177\/1457496914531928","volume":"103","author":"MB de Jong","year":"2014","unstructured":"de Jong MB, Kokke MC, Hietbrink F, Leenen LP. Surgical management of rib fractures: strategies and literature review. Scand J Surg. 2014;103(2):120\u20135. https:\/\/doi.org\/10.1177\/1457496914531928.","journal-title":"Scand J Surg"},{"issue":"1","key":"1864_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/TA.0000000000001729","volume":"84","author":"FM Pieracci","year":"2018","unstructured":"Pieracci FM, Coleman J, Ali-Osman F, Mangram A, Majercik S, White TW, et al. A multicenter evaluation of the optimal timing of surgical stabilization of rib fractures. J Trauma Acute Care Surg. 2018;84(1):1\u201310. https:\/\/doi.org\/10.1097\/TA.0000000000001729.","journal-title":"J Trauma Acute Care Surg"},{"issue":"12","key":"1864_CR8","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1007\/s00113-015-0026-7","volume":"119","author":"S Schulz-Drost","year":"2016","unstructured":"Schulz-Drost S, Oppel P, Grupp S, Krinner S, Langenbach A, Lefering R, et al. Bony injuries of the thoracic cage in multiple trauma: incidence, concomitant injuries, course and outcome. Unfallchirurg. 2016;119(12):1023\u201330. https:\/\/doi.org\/10.1007\/s00113-015-0026-7.","journal-title":"Unfallchirurg"},{"issue":"1","key":"1864_CR9","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1007\/s00268-008-9770-y","volume":"33","author":"R Nirula","year":"2009","unstructured":"Nirula R, Diaz JJ Jr, Trunkey DD, Mayberry JC. Rib fracture repair: indications, technical issues, and future directions. World J Surg. 2009;33(1):14\u201322. https:\/\/doi.org\/10.1007\/s00268-008-9770-y.","journal-title":"World J Surg"},{"issue":"2","key":"1864_CR10","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/j.injury.2016.11.026","volume":"48","author":"FM Pieracci","year":"2017","unstructured":"Pieracci FM, Majercik S, Ali-Osman F, Ang D, Doben A, Edwards JG, et al. Consensus statement: surgical stabilization of rib fractures rib fracture colloquium clinical practice guidelines. Injury. 2017;48(2):307\u201321. https:\/\/doi.org\/10.1016\/j.injury.2016.11.026.","journal-title":"Injury"},{"issue":"Suppl 1","key":"1864_CR11","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s00068-018-0922-y","volume":"44","author":"Polytrauma Guideline Update G","year":"2018","unstructured":"Polytrauma Guideline Update G. Level 3 guideline on the treatment of patients with severe\/multiple injuries: AWMF Register-Nr 012\/019. Eur J Trauma Emerg Surg. 2018;44(Suppl 1):3\u2013271. https:\/\/doi.org\/10.1007\/s00068-018-0922-y.","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"3","key":"1864_CR12","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1055\/a-0774-3401","volume":"144","author":"S Raab","year":"2019","unstructured":"Raab S, Grieser T, Sturm M, Beyer M, Reindl S. Management of Rib Fractures. Zentralbl Chir. 2019;144(3):305\u201321. https:\/\/doi.org\/10.1055\/a-0774-3401.","journal-title":"Zentralbl Chir"},{"issue":"8","key":"1864_CR13","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1007\/s00113-018-0532-5","volume":"121","author":"S Schulz-Drost","year":"2018","unstructured":"Schulz-Drost S, Ekkernkamp A, Stengel D. Epidemiology, injury entities and treatment practice for chest wall injuries: current scientific knowledge and treatment recommendations. Unfallchirurg. 2018;121(8):605\u201314. https:\/\/doi.org\/10.1007\/s00113-018-0532-5.","journal-title":"Unfallchirurg"},{"issue":"2","key":"1864_CR14","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. https:\/\/doi.org\/10.1007\/s00068-016-0721-2.","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"4","key":"1864_CR15","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1016\/j.amjsurg.2015.11.014","volume":"211","author":"L DeFreest","year":"2016","unstructured":"DeFreest L, Tafen M, Bhakta A, Ata A, Martone S, Glotzer O, et al. Open reduction and internal fixation of rib fractures in polytrauma patients with flail chest. Am J Surg. 2016;211(4):761\u20137. https:\/\/doi.org\/10.1016\/j.amjsurg.2015.11.014.","journal-title":"Am J Surg"},{"issue":"6","key":"1864_CR16","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. https:\/\/doi.org\/10.1097\/SLA.0b013e3182895bb0.","journal-title":"Ann Surg"},{"issue":"4","key":"1864_CR17","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-023444","volume":"9","author":"HM Ingoe","year":"2019","unstructured":"Ingoe HM, Coleman E, Eardley W, Rangan A, Hewitt C, McDaid C. Systematic review of systematic reviews for effectiveness of internal fixation for flail chest and rib fractures in adults. BMJ Open. 2019;9(4): e023444. https:\/\/doi.org\/10.1136\/bmjopen-2018-023444.","journal-title":"BMJ Open"},{"issue":"4","key":"1864_CR18","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. https:\/\/doi.org\/10.1007\/s00068-018-1020-x.","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"1","key":"1864_CR19","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s13019-019-0865-3","volume":"14","author":"X Liu","year":"2019","unstructured":"Liu X, Xiong K. Surgical management versus non-surgical management of rib fractures in chest trauma: a systematic review and meta-analysis. J Cardiothorac Surg. 2019;14(1):45. https:\/\/doi.org\/10.1186\/s13019-019-0865-3.","journal-title":"J Cardiothorac Surg"},{"issue":"6","key":"1864_CR20","doi-asserted-by":"publisher","first-page":"1750","DOI":"10.1097\/TA.0b013e31823c85e9","volume":"71","author":"M de Moya","year":"2011","unstructured":"de Moya M, Bramos T, Agarwal S, Fikry K, Janjua S, King DR, et al. Pain as an indication for rib fixation: a bi-institutional pilot study. J Trauma. 2011;71(6):1750\u20134. https:\/\/doi.org\/10.1097\/TA.0b013e31823c85e9.","journal-title":"J Trauma"},{"issue":"2","key":"1864_CR21","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1016\/j.jamcollsurg.2012.02.023","volume":"215","author":"A Bhatnagar","year":"2012","unstructured":"Bhatnagar A, Mayberry J, Nirula R. Rib fracture fixation for flail chest: what is the benefit? J Am Coll Surg. 2012;215(2):201\u20135. https:\/\/doi.org\/10.1016\/j.jamcollsurg.2012.02.023.","journal-title":"J Am Coll Surg"},{"issue":"1","key":"1864_CR22","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.injury.2018.11.005","volume":"50","author":"SF Marasco","year":"2019","unstructured":"Marasco SF, Martin K, Niggemeyer L, Summerhayes R, Fitzgerald M, Bailey M. Impact of rib fixation on quality of life after major trauma with multiple rib fractures. Injury. 2019;50(1):119\u201324. https:\/\/doi.org\/10.1016\/j.injury.2018.11.005.","journal-title":"Injury"},{"issue":"4","key":"1864_CR23","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1007\/s00068-018-1037-1","volume":"45","author":"RB Beks","year":"2019","unstructured":"Beks RB, Reetz D, de Jong MB, Groenwold RHH, Hietbrink F, Edwards MJR, et al. Rib fixation versus non-operative treatment for flail chest and multiple rib fractures after blunt thoracic trauma: a multicenter cohort study. Eur J Trauma Emerg Surg. 2019;45(4):655\u201363. https:\/\/doi.org\/10.1007\/s00068-018-1037-1.","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"6","key":"1864_CR24","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1080\/00015458.2015.11681142","volume":"115","author":"YB Buyukkarabacak","year":"2015","unstructured":"Buyukkarabacak YB, Sengul AT, Celik B, Abaci SH, Pirzirenli MG, Gurz S, et al. The usefulness of early surgical rib stabilization in flail chest. Acta Chir Belg. 2015;115(6):408\u201313. https:\/\/doi.org\/10.1080\/00015458.2015.11681142.","journal-title":"Acta Chir Belg"},{"issue":"2","key":"1864_CR25","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1097\/ta.0000000000000086","volume":"76","author":"N Dehghan","year":"2014","unstructured":"Dehghan N, de Mestral C, McKee MD, Schemitsch EH, Nathens A. Flail chest injuries: a review of outcomes and treatment practices from the National Trauma Data Bank. J Trauma Acute Care Surg. 2014;76(2):462\u20138. https:\/\/doi.org\/10.1097\/ta.0000000000000086.","journal-title":"J Trauma Acute Care Surg"},{"issue":"1","key":"1864_CR26","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1097\/bot.0000000000000992","volume":"32","author":"N Dehghan","year":"2018","unstructured":"Dehghan N, Mah JM, Schemitsch EH, Nauth A, Vicente M, McKee MD. Operative stabilization of flail chest injuries reduces mortality to that of stable chest wall injuries. J Orthop Trauma. 2018;32(1):15\u201321. https:\/\/doi.org\/10.1097\/bot.0000000000000992.","journal-title":"J Orthop Trauma"},{"issue":"1","key":"1864_CR27","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1097\/bot.0000000000001264","volume":"33","author":"E Gerakopoulos","year":"2019","unstructured":"Gerakopoulos E, Walker L, Melling D, Scott S, Scott S. Surgical management of multiple rib fractures reduces the hospital length of stay and the mortality rate in major trauma patients: a comparative study in a UK Major Trauma Center. J Orthop Trauma. 2019;33(1):9\u201314. https:\/\/doi.org\/10.1097\/bot.0000000000001264.","journal-title":"J Orthop Trauma"},{"issue":"6","key":"1864_CR28","doi-asserted-by":"publisher","first-page":"1227","DOI":"10.1016\/j.jcrc.2015.07.027","volume":"30","author":"T Wada","year":"2015","unstructured":"Wada T, Yasunaga H, Inokuchi R, Matsui H, Matsubara T, Ueda Y, et al. Effectiveness of surgical rib fixation on prolonged mechanical ventilation in patients with traumatic rib fractures: a propensity score-matched analysis. J Crit Care. 2015;30(6):1227\u201331. https:\/\/doi.org\/10.1016\/j.jcrc.2015.07.027.","journal-title":"J Crit Care"},{"issue":"2","key":"1864_CR29","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1093\/icvts\/ivw092","volume":"23","author":"K Schulte","year":"2016","unstructured":"Schulte K, Whitaker D, Attia R. In patients with acute flail chest does surgical rib fixation improve outcomes in terms of morbidity and mortality? Interact Cardiovasc Thorac Surg. 2016;23(2):314\u20139. https:\/\/doi.org\/10.1093\/icvts\/ivw092.","journal-title":"Interact Cardiovasc Thorac Surg"}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-021-01864-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-021-01864-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-021-01864-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,8]],"date-time":"2022-08-08T10:09:53Z","timestamp":1659953393000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00068-021-01864-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,3]]},"references-count":29,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,8]]}},"alternative-id":["1864"],"URL":"https:\/\/doi.org\/10.1007\/s00068-021-01864-0","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-414852\/v1","asserted-by":"object"}]},"ISSN":["1863-9933","1863-9941"],"issn-type":[{"value":"1863-9933","type":"print"},{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,3]]},"assertion":[{"value":"5 April 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 December 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 February 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interests or competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest\/competing interest"}},{"value":"This study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. It was performed in accordance with the publication guideline of TraumaRegister DGU<sup>\u00ae<\/sup> and is registered as TR-DGU Project ID 2017-030. According to the guidelines of the responsible state medical association, an ethical vote was not necessary in a retrospective anonymous analysis.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}]}}