{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T07:38:37Z","timestamp":1792136317426,"version":"4.4.0"},"reference-count":50,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T00:00:00Z","timestamp":1737072000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T00:00:00Z","timestamp":1737072000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002839","name":"Charit\u00e9 - Universit\u00e4tsmedizin Berlin","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002839","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":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Flail chest (FC) injuries are segmental osseous injuries of the thorax that typically result from high-energy blunt trauma and regularly occur in multiple trauma (MT) patients. FC injuries are associated with paradoxical chest wall movements and, thus, have a high risk of respiratory insufficiency or even death. An increasing number of studies recommend an early surgical stabilization of FC injuries, but a definite trigger that would indicate surgery has, thus far, not been identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Based on real-world injury computed tomography (CT) data, this study aimed to establish a finite elements (FE) model of a thorax simulating spontaneous breathing. The model is based on a 0.625\u00a0mm slice thickness CT data set. In this FE model, various FC injury patterns were implemented to examine the impact of an increasingly large flail segment on tidal volume and respiratory work. The impact of the segmental defect sizes on the outcome measures mentioned above was examined using correlation analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The FE model in this study reliably simulated the spontaneous breathing patterns of an actively breathing patient in an uninjured setting as a reference and showed clinically realistic movements of the flail segments for various injury settings. Correlation analysis showed a significant negative correlation between the FC size and tidal volume (R\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.852,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), while absolute (R\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.845,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0096) and relative loss (R\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.844,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0096) of tidal volume concerning the intact model and the compensatory respiratory work required (R\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.816,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0136) were positively correlated with FC size.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study presents an FE model of the thorax of a patient who presented to our clinic as an MT patient with an FC injury. The FE model fulfills physiologic active breathing patterns and simulates an FC injury\u2019s paradoxical movement, realistically depicting clinical observations. The FE model showed that the number of consecutive ribs involved in the flail segment and the length of the flail segment significantly impacted active breathing concerning tidal volumes and respiratory work. With this, we have made the first step to define a trigger for surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00068-024-02754-x","type":"journal-article","created":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T07:59:50Z","timestamp":1737100790000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Biomechanics of flail chest injuries: tidal volume and respiratory work changes in multiple segmental rib fractures"],"prefix":"10.1007","volume":"51","author":[{"given":"Julian N.","family":"Zierke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg N.","family":"Duda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl F.","family":"Braun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera","family":"Jaecker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"St\u00f6ckle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Damm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Heyland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Niemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,17]]},"reference":[{"issue":"12","key":"2754_CR1","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1136\/EMJ.2006.037945","volume":"23","author":"JB Borman","year":"2006","unstructured":"Borman JB, et al. Unilateral flail chest is seldom a lethal injury. Emerg Med J. 2006;23(12):903\u20135. https:\/\/doi.org\/10.1136\/EMJ.2006.037945.","journal-title":"Emerg Med J"},{"issue":"2","key":"2754_CR2","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1097\/TA.0000000000000086","volume":"76","author":"N Dehghan","year":"2014","unstructured":"Dehghan N, et al. 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":"12","key":"2754_CR3","doi-asserted-by":"publisher","first-page":"e0224105","DOI":"10.1371\/JOURNAL.PONE.0224105","volume":"14","author":"C Liebsch","year":"2019","unstructured":"Liebsch C, et al. Patterns of serial rib fractures after blunt chest trauma: an analysis of 380 cases. PloS one. 2019;14(12):e0224105. https:\/\/doi.org\/10.1371\/JOURNAL.PONE.0224105.","journal-title":"PloS one"},{"key":"2754_CR4","unstructured":"Ronan O\u2019Rahilly and Fabiola M\u00fcller (1983) Basic Human Anatomy - A Regional Study of Human Structure. Michigan: Saunders. Available at: https:\/\/humananatomy.host.dartmouth.edu\/BHA\/public_html\/ (Accessed: 22 August 2023)."},{"key":"2754_CR5","unstructured":"John B. West (2012) Respiritory physiology: the essentials. 9th edn, Vasa. 9th edn. Philadelphia: Wolters Kluwer Health\/Lippincott Williams & Wilkins. Available at: https:\/\/www.worldcat.org\/title\/723034847 (Accessed: 9 August 2023)."},{"issue":"2","key":"2754_CR6","doi-asserted-by":"publisher","first-page":"E40","DOI":"10.1097\/TA.0000000000002282","volume":"88","author":"JG Edwards","year":"2020","unstructured":"Edwards JG, et al. Taxonomy of multiple rib fractures: Results of the chest wall injury society international consensus survey. J Trauma Acute Care Surg. 2020;88(2):E40\u20135. https:\/\/doi.org\/10.1097\/TA.0000000000002282.","journal-title":"J Trauma Acute Care Surg"},{"issue":"5","key":"2754_CR7","doi-asserted-by":"publisher","first-page":"1425","DOI":"10.1007\/S00264-009-0746-9","volume":"33","author":"VT Veysi","year":"2009","unstructured":"Veysi VT, et al. Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience. Int Orthop. 2009;33(5):1425\u201333. https:\/\/doi.org\/10.1007\/S00264-009-0746-9.","journal-title":"Int Orthop"},{"issue":"6","key":"2754_CR8","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.1097\/01.TA.0000060262.76267.EF","volume":"54","author":"MA Kerr-Valentic","year":"2003","unstructured":"Kerr-Valentic MA, et al. Rib fracture pain and disability: can we do better? J Trauma. 2003;54(6):1058\u201364. https:\/\/doi.org\/10.1097\/01.TA.0000060262.76267.EF.","journal-title":"J Trauma"},{"issue":"7","key":"2754_CR9","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1055\/s-0037-1598194","volume":"65","author":"S Schulz-Drost","year":"2017","unstructured":"Schulz-Drost S, et al. Concomitant sternal fracture in flail chest: an analysis of 21,741 polytrauma patients from the traumaregister DGU \u00ae. Thoracic Cardiovasc Surg. 2017;65(7):551\u20139. https:\/\/doi.org\/10.1055\/s-0037-1598194.","journal-title":"Thoracic Cardiovasc Surg"},{"issue":"6","key":"2754_CR10","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1510\/icvts.2005.111807","volume":"4","author":"A Granetzny","year":"2005","unstructured":"Granetzny A, et al. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact Cardiovasc Thorac Surg. 2005;4(6):583\u20137. https:\/\/doi.org\/10.1510\/icvts.2005.111807.","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"5","key":"2754_CR11","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, et al. Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg. 2013;216(5):924\u201332. https:\/\/doi.org\/10.1016\/J.JAMCOLLSURG.2012.12.024.","journal-title":"J Am Coll Surg"},{"issue":"4","key":"2754_CR12","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1097\/00005373-200204000-00020","volume":"52","author":"H Tanaka","year":"2002","unstructured":"Tanaka 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. https:\/\/doi.org\/10.1097\/00005373-200204000-00020.","journal-title":"J Trauma"},{"issue":"8","key":"2754_CR13","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1302\/0301-620X.98B8.37282","volume":"98-B","author":"TA Coughlin","year":"2016","unstructured":"Coughlin TA, et al. Management of rib fractures in traumatic flail chest: a meta-analysis of randomised controlled trials. Bone Joint J. 2016;98-B(8):1119\u201325. https:\/\/doi.org\/10.1302\/0301-620X.98B8.37282.","journal-title":"Bone Joint J"},{"issue":"1","key":"2754_CR14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/S13019-015-0363-1\/TABLES\/5","volume":"10","author":"X Zhang","year":"2015","unstructured":"Zhang X, et al. Management of patients with flail chest by surgical fixation using claw-type titanium plate. J Cardiothorac Surg. 2015;10(1):1\u20137. https:\/\/doi.org\/10.1186\/S13019-015-0363-1\/TABLES\/5.","journal-title":"J Cardiothorac Surg"},{"issue":"7","key":"2754_CR15","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1016\/J.AJEM.2015.04.005","volume":"33","author":"Y Zhang","year":"2015","unstructured":"Zhang Y, et al. Comparison of surgical fixation and nonsurgical management of flail chest and pulmonary contusion. Am J Emerg Med. 2015;33(7):937\u201340. https:\/\/doi.org\/10.1016\/J.AJEM.2015.04.005.","journal-title":"Am J Emerg Med"},{"issue":"8","key":"2754_CR16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/JCM9082379","volume":"9","author":"M Niemann","year":"2020","unstructured":"Niemann M, et al. Retrospective analysis of the clinical outcome in a matched case-control cohort of polytrauma patients following an osteosynthetic flail chest stabilization. J Clin Med. 2020;9(8):1\u20139. https:\/\/doi.org\/10.3390\/JCM9082379.","journal-title":"J Clin Med"},{"issue":"2","key":"2754_CR17","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.cmpb.2010.06.017","volume":"101","author":"KL Steimle","year":"2011","unstructured":"Steimle KL, et al. A model of ventilation of the healthy human lung. Comput Methods Programs Biomed. 2011;101(2):144\u201355. https:\/\/doi.org\/10.1016\/j.cmpb.2010.06.017.","journal-title":"Comput Methods Programs Biomed"},{"issue":"1","key":"2754_CR18","doi-asserted-by":"publisher","first-page":"25","DOI":"10.4103\/0974-2700.125635","volume":"7","author":"S Arora","year":"2014","unstructured":"Arora S, Singh PM, Trikha A. Ventilatory strategies in trauma patients. J Emerg Trauma Shock. 2014;7(1):25. https:\/\/doi.org\/10.4103\/0974-2700.125635.","journal-title":"J Emerg Trauma Shock"},{"key":"2754_CR19","first-page":"3181","volume-title":"Spirometra","author":"W Liu","year":"2023","unstructured":"Liu W, et al. Molecular medical microbiology. In: Spirometra. 3rd ed. Elsevier; 2023. p. 3181\u20139.","edition":"3"},{"issue":"5","key":"2754_CR20","doi-asserted-by":"publisher","first-page":"1531","DOI":"10.1152\/JAPPL.1997.83.5.1531","volume":"83","author":"A De Groote","year":"1997","unstructured":"De Groote A, et al. Chest wall motion during tidal breathing. J Appl Physiol (Bethesda MD 1985). 1997;83(5):1531\u20137. https:\/\/doi.org\/10.1152\/JAPPL.1997.83.5.1531.","journal-title":"J Appl Physiol (Bethesda MD 1985)"},{"issue":"6Part1","key":"2754_CR21","doi-asserted-by":"publisher","first-page":"1647","DOI":"10.1118\/1.1915012","volume":"32","author":"KK Brock","year":"2005","unstructured":"Brock KK, et al. Accuracy of finite element model-based multi-organ deformable image registration. Med Phys. 2005;32(6Part1):1647\u201359. https:\/\/doi.org\/10.1118\/1.1915012.","journal-title":"Med Phys"},{"issue":"22","key":"2754_CR22","doi-asserted-by":"publisher","first-page":"8833","DOI":"10.1088\/0031-9155\/60\/22\/8833","volume":"60","author":"JN Tehrani","year":"2015","unstructured":"Tehrani JN, et al. Sensitivity of tumor motion simulation accuracy to lung biomechanical modeling approaches and parameters. Phys Med Biol. 2015;60(22):8833. https:\/\/doi.org\/10.1088\/0031-9155\/60\/22\/8833.","journal-title":"Phys Med Biol"},{"key":"2754_CR23","first-page":"696","volume-title":"Physiologie der Atmung","author":"R Larsen","year":"2016","unstructured":"Larsen R. An\u00e4sthesie und Intensivmedizin f\u00fcr die Fachpflege. In: Physiologie der Atmung. Berlin: Springer; 2016. p. 696\u2013708."},{"key":"2754_CR24","doi-asserted-by":"publisher","DOI":"10.4271\/2006-01-0250","author":"NL Ritchie","year":"2006","unstructured":"Ritchie NL, et al. \u2018A method for documenting locations of rib fractures for occupants in real-world crashes using medical computed tomography (CT) scans. SAE Techn Papers SAE Int. 2006. https:\/\/doi.org\/10.4271\/2006-01-0250.","journal-title":"SAE Techn Papers SAE Int"},{"issue":"1","key":"2754_CR25","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1186\/s13049-015-0137-8","volume":"23","author":"G Reith","year":"2015","unstructured":"Reith G, et al. Injury pattern, outcome and characteristics of severely injured pedestrian. Scand J Trauma Resuscitat Emerg Med. 2015;23(1):56. https:\/\/doi.org\/10.1186\/s13049-015-0137-8.","journal-title":"Scand J Trauma Resuscitat Emerg Med"},{"issue":"1","key":"2754_CR26","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1007\/s00068-011-0114-5","volume":"38","author":"T Topp","year":"2012","unstructured":"Topp T, et al. Multiple blunt trauma after suicidal attempt: an analysis of 4,754 multiple severely injured patients. Eur J Trauma Emerg Surg. 2012;38(1):19\u201324. https:\/\/doi.org\/10.1007\/s00068-011-0114-5.","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"5","key":"2754_CR27","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1177\/000313481908500523","volume":"85","author":"FA Cheema","year":"2019","unstructured":"Cheema FA, et al. State of rib fracture care: a NTDB review of analgesic management and surgical stabilization. Am Surg. 2019;85(5):474\u20138. https:\/\/doi.org\/10.1177\/000313481908500523.","journal-title":"Am Surg"},{"issue":"6","key":"2754_CR28","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1097\/TA.0000000000001648","volume":"83","author":"ED Kane","year":"2017","unstructured":"Kane ED, et al. Quantifying and exploring the recent national increase in surgical stabilization of rib fractures. J Trauma Acute Care Surg. 2017;83(6):1047\u201352. https:\/\/doi.org\/10.1097\/TA.0000000000001648.","journal-title":"J Trauma Acute Care Surg"},{"issue":"11","key":"2754_CR29","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1097\/BOT.0b013e318234d479","volume":"25","author":"PL Althausen","year":"2011","unstructured":"Althausen PL, et al. Early surgical stabilization of flail chest with locked plate fixation. J Orthop Trauma. 2011;25(11):641\u20137. https:\/\/doi.org\/10.1097\/BOT.0b013e318234d479.","journal-title":"J Orthop Trauma"},{"issue":"8","key":"2754_CR30","doi-asserted-by":"publisher","first-page":"575","DOI":"10.5435\/JAAOS-D-15-00476","volume":"24","author":"BC Taylor","year":"2016","unstructured":"Taylor BC, et al. Clinical outcomes of surgical stabilization of flail chest injury. J Am Acad Orthop Surg. 2016;24(8):575\u201380. https:\/\/doi.org\/10.5435\/JAAOS-D-15-00476.","journal-title":"J Am Acad Orthop Surg"},{"issue":"5","key":"2754_CR31","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1177\/000313481608200502","volume":"82","author":"M Velasquez","year":"2016","unstructured":"Velasquez M, et al. Operative versus nonoperative management of multiple rib fractures. Am Surg. 2016;82(5):103.\u00a0https:\/\/doi.org\/10.1177\/000313481608200502.","journal-title":"Am Surg"},{"key":"2754_CR32","unstructured":"Wu, W. M. et al. (2015) Which is better to multiple rib fractures, surgical treatment or conservative treatment?  Int J Clin Exp Med 8(5): 7930. Available at: https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC4509295\/. Accessed 28 Jan 2024"},{"issue":"4","key":"2754_CR33","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1007\/S00068-016-0687-0","volume":"43","author":"K Uchida","year":"2017","unstructured":"Uchida K, et al. Evaluation of efficacy and indications of surgical fixation for multiple rib fractures: a propensity-score matched analysis. Euro J Trauma Emerg Surg Offi Publ Euro Trauma Soci. 2017;43(4):541\u20137. https:\/\/doi.org\/10.1007\/S00068-016-0687-0.","journal-title":"Euro J Trauma Emerg Surg Offi Publ Euro Trauma Soci"},{"issue":"6","key":"2754_CR34","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1097\/TA.0000000000003790","volume":"93","author":"SFM Van Wijck","year":"2022","unstructured":"Van Wijck SFM, et al. Rib fixation in patients with severe rib fractures and pulmonary contusions: Is it safe? J Trauma Acute Care Surg. 2022;93(6):721\u20136. https:\/\/doi.org\/10.1097\/TA.0000000000003790.","journal-title":"J Trauma Acute Care Surg"},{"issue":"3","key":"2754_CR35","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1007\/S00068-018-0961-4","volume":"46","author":"MME Wijffels","year":"2020","unstructured":"Wijffels MME, Hagenaars T, et al. Early results after operatively versus non-operatively treated flail chest: a retrospective study focusing on outcome and complications. Euro J Trauma Emerg Surg Offi Publ Euro Trauma Soci. 2020;46(3):539\u201347. https:\/\/doi.org\/10.1007\/S00068-018-0961-4.","journal-title":"Euro J Trauma Emerg Surg Offi Publ Euro Trauma Soci"},{"issue":"11","key":"2754_CR36","doi-asserted-by":"publisher","first-page":"2368","DOI":"10.1016\/J.INJURY.2020.07.009","volume":"51","author":"MME Wijffels","year":"2020","unstructured":"Wijffels MME, Prins JTH, et al. Operative versus nonoperative treatment of multiple simple rib fractures: a systematic review and meta-analysis. Injury. 2020;51(11):2368\u201378. https:\/\/doi.org\/10.1016\/J.INJURY.2020.07.009.","journal-title":"Injury"},{"issue":"6","key":"2754_CR37","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1007\/S12262-015-1409-2","volume":"78","author":"M Qiu","year":"2016","unstructured":"Qiu M, et al. Potential benefits of rib fracture fixation in patients with flail chest and multiple non-flail rib fractures. Ind J Surg. 2016;78(6):458\u201363. https:\/\/doi.org\/10.1007\/S12262-015-1409-2.","journal-title":"Ind J Surg"},{"issue":"12","key":"2754_CR38","doi-asserted-by":"publisher","first-page":"2890","DOI":"10.1007\/S00268-022-06748-X","volume":"46","author":"J Dilday","year":"2022","unstructured":"Dilday J, et al. Surgical rib fixation in obese patients with isolated flail chest improves outcomes: a matched cohort study. World J Surg. 2022;46(12):2890\u20139. https:\/\/doi.org\/10.1007\/S00268-022-06748-X.","journal-title":"World J Surg"},{"issue":"4","key":"2754_CR39","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1097\/JS9.0000000000000271","volume":"109","author":"CA Liao","year":"2023","unstructured":"Liao CA, et al. Timely surgical fixation confers beneficial outcomes in patients\u2019 concomitant flail chest with mild-to-moderate traumatic brain injury: a trauma quality improvement project analysis\u2014A cohort study. Int J Surg (London, England). 2023;109(4):729\u201336. https:\/\/doi.org\/10.1097\/JS9.0000000000000271.","journal-title":"Int J Surg (London, England)"},{"issue":"4","key":"2754_CR40","doi-asserted-by":"publisher","first-page":"2773","DOI":"10.1007\/s00068-021-01864-0","volume":"48","author":"L Becker","year":"2022","unstructured":"Becker L, et al. Effect of surgical stabilization of rib fractures in polytrauma: an analysis of the TraumaRegister DGU\u00ae. Eur J Trauma Emerg Surg. 2022;48(4):2773\u201381. https:\/\/doi.org\/10.1007\/s00068-021-01864-0.","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2754_CR41","unstructured":"Becker, Lars et al. (2022b) \u2018Einfluss der operativen Rippenstabilisierung auf das Outcome beim polytraumatisierten Patienten \u2013 Eine Analyse aus dem TraumaRegister DGU(R)\u2019, in German Congress of Orthopedics and Traumatology (DKOU 2022). D\u00fcsseldorf. Available at: https:\/\/www.egms.de\/static\/en\/meetings\/dkou2021\/21dkou638.shtml (Accessed: 25 November 2024)."},{"key":"2754_CR42","doi-asserted-by":"publisher","unstructured":"Becker, L et al. (2022) \u2018Einfluss des Zeitpunktes einer operativen Rippenstabilisierung auf das Outcome bei polytraumatisierten Patienten \u2013 eine matched-pairs Analyse aus dem TraumaRegister DGU\u00ae\u2019, in 31. Jahrestagung der Deutschen Gesellschaft f\u00fcr Thoraxchirurgie. Georg Thieme Verlag, pp. V\u2013133. https:\/\/doi.org\/10.1055\/s-0042-1754258.","DOI":"10.1055\/s-0042-1754258"},{"issue":"1","key":"2754_CR43","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1097\/TA.0000000000002666","volume":"89","author":"R Chen Zhu","year":"2020","unstructured":"Chen Zhu R, et al. Rib fixation in geriatric trauma: Mortality benefits for the most vulnerable patients. J Trauma Acute Care Surg. 2020;89(1):103\u201310. https:\/\/doi.org\/10.1097\/TA.0000000000002666.","journal-title":"J Trauma Acute Care Surg"},{"issue":"6","key":"2754_CR44","doi-asserted-by":"publisher","first-page":"1859","DOI":"10.1016\/J.ATHORACSUR.2021.05.085","volume":"113","author":"N Owattanapanich","year":"2022","unstructured":"Owattanapanich N, et al. Surgical rib fixation in isolated flail chest improves survival. Ann Thorac Surg. 2022;113(6):1859\u201365. https:\/\/doi.org\/10.1016\/J.ATHORACSUR.2021.05.085.","journal-title":"Ann Thorac Surg"},{"issue":"1","key":"2754_CR45","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1097\/BOT.0000000000001344","volume":"33","author":"ST Walters","year":"2019","unstructured":"Walters ST, et al. Surgical stabilization improves 30-day mortality in patients with traumatic flail chest: a comparative case series at a major trauma center. J Orthop Trauma. 2019;33(1):15\u201322. https:\/\/doi.org\/10.1097\/BOT.0000000000001344.","journal-title":"J Orthop Trauma"},{"issue":"8","key":"2754_CR46","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1016\/0021-9290(77)90104-X","volume":"10","author":"SH Sundaram","year":"1977","unstructured":"Sundaram SH, Feng CC. Finite element analysis of the human thorax. J Biomech. 1977;10(8):505\u201316. https:\/\/doi.org\/10.1016\/0021-9290(77)90104-X.","journal-title":"J Biomech"},{"key":"2754_CR47","doi-asserted-by":"publisher","DOI":"10.1186\/S12938-016-0132-Y","author":"G Zhang","year":"2016","unstructured":"Zhang G, et al. Biomechanical simulation of thorax deformation using finite element approach. Biomed Eng Online. 2016. https:\/\/doi.org\/10.1186\/S12938-016-0132-Y.","journal-title":"Biomed Eng Online"},{"issue":"6","key":"2754_CR48","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1097\/TA.0000000000003780","volume":"93","author":"ZM Bauman","year":"2022","unstructured":"Bauman ZM, et al. Finite element analysis for better evaluation of rib fractures: a pilot study. J Trauma Acute Care Surg. 2022;93(6):767\u201373. https:\/\/doi.org\/10.1097\/TA.0000000000003780.","journal-title":"J Trauma Acute Care Surg"},{"key":"2754_CR49","doi-asserted-by":"publisher","DOI":"10.1016\/J.CLINBIOMECH.2020.105191","author":"DM Myers","year":"2020","unstructured":"Myers DM, et al. A model for evaluating the biomechanics of rib fracture fixation. Clin Biomech (Bristol, Avon). 2020. https:\/\/doi.org\/10.1016\/J.CLINBIOMECH.2020.105191.","journal-title":"Clin Biomech (Bristol, Avon)"},{"key":"2754_CR50","unstructured":"Patrick T. Delaplain et al. (2020) Chest Wall Injury Society Guideline for SSRF Indications, Contraindications and Timing. Available at: https:\/\/cwisociety.org\/wp-content\/uploads\/2020\/05\/CWIS-SSRF-Guideline-01102020.pdf (Accessed: 25 November 2024)."}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-024-02754-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-024-02754-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-024-02754-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T21:02:35Z","timestamp":1770757355000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00068-024-02754-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,17]]},"references-count":50,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["2754"],"URL":"https:\/\/doi.org\/10.1007\/s00068-024-02754-x","relation":{},"ISSN":["1863-9933","1863-9941"],"issn-type":[{"value":"1863-9933","type":"print"},{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,17]]},"assertion":[{"value":"5 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 December 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 January 2025","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 no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"25"}}