{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T22:15:10Z","timestamp":1792707310456,"version":"4.5.0"},"reference-count":76,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T00:00:00Z","timestamp":1659312000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T00:00:00Z","timestamp":1659312000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T00:00:00Z","timestamp":1659312000000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T00:00:00Z","timestamp":1659312000000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T00:00:00Z","timestamp":1659312000000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T00:00:00Z","timestamp":1659312000000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T00:00:00Z","timestamp":1659312000000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","journalofsurgicalresearch.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Research"],"published-print":{"date-parts":[[2022,8]]},"DOI":"10.1016\/j.jss.2022.02.055","type":"journal-article","created":{"date-parts":[[2022,4,4]],"date-time":"2022-04-04T13:22:41Z","timestamp":1649078561000},"page":"221-234","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":101,"special_numbering":"C","title":["Surgical Rib Fixation of Multiple Rib Fractures and Flail Chest: A Systematic Review and Meta-analysis"],"prefix":"10.1016","volume":"276","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1717-677X","authenticated-orcid":false,"given":"Emily","family":"Sawyer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Wullschleger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Muller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Muller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.jss.2022.02.055_bib1","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1097\/SLA.0b013e3182895bb0","article-title":"Operative management of rib fractures in the setting of flail chest: a systematic review and meta-analysis","volume":"258","author":"Leinicke","year":"2013","journal-title":"Ann Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib2","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1097\/CORR.0000000000000495","article-title":"Does surgery reduce the risk of complications among patients with multiple rib fractures? A meta-analysis","volume":"477","author":"Liang","year":"2019","journal-title":"Clin Orthop Relat Res"},{"key":"10.1016\/j.jss.2022.02.055_bib3","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1016\/j.surg.2005.07.022","article-title":"Half-a-dozen ribs: the breakpoint for mortality","volume":"138","author":"Flagel","year":"2005","journal-title":"Surgery"},{"key":"10.1016\/j.jss.2022.02.055_bib4","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1007\/s00068-020-01353-w","article-title":"Rib fracture displacement worsens over time","volume":"47","author":"Bauman","year":"2021","journal-title":"Eur J Trauma Emerg Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib5","doi-asserted-by":"crossref","first-page":"97","DOI":"10.2106\/JBJS.I.00696","article-title":"Operative treatment of chest wall injuries: indications, technique, and outcomes","volume":"93","author":"Lafferty","year":"2011","journal-title":"J Bone Joint Surg Am"},{"key":"10.1016\/j.jss.2022.02.055_bib6","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1007\/s00068-020-01412-2","article-title":"Epidemiology and outcome of rib fractures: a nationwide study in The Netherlands","volume":"48","author":"Peek","year":"2022","journal-title":"Eur J Trauma Emerg Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib7","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.injury.2011.01.004","article-title":"Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis","volume":"43","author":"Battle","year":"2012","journal-title":"Injury"},{"key":"10.1016\/j.jss.2022.02.055_bib76","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/TA.0000000000000925","article-title":"A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures","volume":"80","author":"Pieracci","year":"2016","journal-title":"J Trauma Acute Care Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib8","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/TA.0000000000002559","article-title":"A multicenter, prospective, controlled clinical trial of surgical stabilization of rib fractures in patients with severe, nonflail fracture patterns (Chest Wall Injury Society NONFLAIL)","volume":"88","author":"Pieracci","year":"2020","journal-title":"J Trauma Acute Care Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib9","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1007\/s00068-018-1020-x","article-title":"Fixation of flail chest or multiple rib fractures: current evidence and how to proceed. A systematic review and meta-analysis","volume":"45","author":"Beks","year":"2019","journal-title":"Eur J Trauma Emerg Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib10","first-page":"CD009919","article-title":"Surgical versus nonsurgical interventions for flail chest","author":"Cataneo","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.jss.2022.02.055_bib11","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1302\/0301-620X.98B8.37282","article-title":"Management of rib fractures in traumatic flail chest: a meta-analysis of randomised controlled trials","volume":"98-b","author":"Coughlin","year":"2016","journal-title":"Bone Joint J"},{"key":"10.1016\/j.jss.2022.02.055_bib12","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.ijsu.2020.09.010","article-title":"Clinical efficacy of surgical versus conservative treatment for multiple rib fractures: a meta-analysis of randomized controlled trials","volume":"83","author":"Long","year":"2020","journal-title":"Int J Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib13","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1007\/s00068-016-0721-2","article-title":"Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review","volume":"43","author":"Schuurmans","year":"2017","journal-title":"Eur J Trauma Emerg Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib14","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.jamcollsurg.2012.10.010","article-title":"Surgical fixation vs nonoperative management of flail chest: a meta-analysis","volume":"216","author":"Slobogean","year":"2013","journal-title":"J Am Coll Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib15","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1097\/BOT.0000000000000750","article-title":"Operative treatment of rib fractures in flail chest injuries: a meta-analysis and cost-effectiveness analysis","volume":"31","author":"Swart","year":"2017","journal-title":"J Orthop Trauma"},{"key":"10.1016\/j.jss.2022.02.055_bib16","first-page":"1","article-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","author":"Apampa","year":"2021","journal-title":"Eur J Trauma Emerg Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib17","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.jamcollsurg.2020.10.022","article-title":"Surgical stabilization of rib fracture to mitigate pulmonary complication and mortality: a systematic review and bayesian meta-analysis","volume":"232","author":"Choi","year":"2021","journal-title":"J Am Coll Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib18","doi-asserted-by":"crossref","first-page":"264","DOI":"10.7326\/0003-4819-151-4-200908180-00135","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"151","author":"Moher","year":"2009","journal-title":"Ann Intern Med"},{"key":"10.1016\/j.jss.2022.02.055_bib19","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/2046-4053-1-2","article-title":"The nuts and bolts of PROSPERO: an international prospective register of systematic reviews","volume":"1","author":"Booth","year":"2012","journal-title":"Syst Rev"},{"key":"10.1016\/j.jss.2022.02.055_bib20","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"10.1016\/j.jss.2022.02.055_bib21","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"10.1016\/j.jss.2022.02.055_bib22","doi-asserted-by":"crossref","first-page":"141","DOI":"10.11613\/BM.2015.015","article-title":"Understanding Bland altman analysis","volume":"25","author":"Giavarina","year":"2015","journal-title":"Biochem Med (Zagreb)"},{"key":"10.1016\/j.jss.2022.02.055_bib23","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/1471-2288-5-13","article-title":"Estimating the mean and variance from the median, range, and the size of a sample","volume":"5","author":"Hozo","year":"2005","journal-title":"BMC Med Res Methodol"},{"key":"10.1016\/j.jss.2022.02.055_bib24","series-title":"Publication Bias in Meta-Analysis","first-page":"99","article-title":"Regression methods to detect publication and other bias in meta-analysis","author":"Sterne","year":"2005"},{"key":"10.1016\/j.jss.2022.02.055_bib25","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1016\/j.amjsurg.2015.08.008","article-title":"Surgical stabilization of severe rib fractures decreases incidence of retained hemothorax and empyema","volume":"210","author":"Majercik","year":"2015","journal-title":"Am J Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib26","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1097\/TA.0000000000000820","article-title":"In-hospital outcomes and costs of surgical stabilization versus nonoperative management of severe rib fractures","volume":"79","author":"Majercik","year":"2015","journal-title":"J Trauma Acute Care Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib27","doi-asserted-by":"crossref","first-page":"331","DOI":"10.5606\/tgkdc.dergisi.2020.18439","article-title":"The benefits of early rib fixation for\u00a0clinical outcomes of flail chest patients in intensive care unit","volume":"28","author":"A\u011fababao\u011flu","year":"2019","journal-title":"Turk Gogus Kalp Damar Cerrahisi Derg"},{"key":"10.1016\/j.jss.2022.02.055_bib53","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.amjsurg.2018.02.022","article-title":"Geriatric (G60) trauma patients with severe rib fractures: is muscle sparing minimally invasive thoracotomy rib fixation safe and does it improve post-operative pulmonary function?","volume":"216","author":"Ali-Osman","year":"2018","journal-title":"Am J Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib54","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1097\/BOT.0b013e318234d479","article-title":"Early surgical stabilization of flail chest with locked plate fixation","volume":"25","author":"Althausen","year":"2011","journal-title":"J Orthop Trauma"},{"key":"10.1016\/j.jss.2022.02.055_bib44","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1007\/s00068-018-1037-1","article-title":"Rib fixation versus non-operative treatment for flail chest and multiple rib fractures after blunt thoracic trauma: a multicenter cohort study","volume":"45","author":"Beks","year":"2019","journal-title":"Eur J Trauma Emerg Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib55","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1080\/00015458.2015.11681142","article-title":"The usefulness of early surgical rib stabilization in flail chest","volume":"115","author":"Buyukkarabacak","year":"2015","journal-title":"Acta Chir Belg"},{"key":"10.1016\/j.jss.2022.02.055_bib56","first-page":"1750","article-title":"Pain as an indication for rib fixation: a bi-institutional pilot study","volume":"71","author":"de Moya","year":"2011","journal-title":"J Trauma"},{"key":"10.1016\/j.jss.2022.02.055_bib57","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/j.amjsurg.2015.11.014","article-title":"Open reduction and internal fixation of rib fractures in polytrauma patients with flail chest","volume":"211","author":"DeFreest","year":"2016","journal-title":"Am J Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib58","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/BOT.0000000000000992","article-title":"Operative stabilization of flail chest injuries reduces mortality to that of stable chest wall injuries","volume":"32","author":"Dehghan","year":"2018","journal-title":"J Orthop Trauma"},{"key":"10.1016\/j.jss.2022.02.055_bib59","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.jcrc.2013.08.003","article-title":"Surgical rib fixation for flail chest deformity improves liberation from mechanical ventilation","volume":"29","author":"Doben","year":"2014","journal-title":"J Crit Care"},{"key":"10.1016\/j.jss.2022.02.055_bib28","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1503\/cjs.000515","article-title":"No benefit to surgical fixation of flail chest injuries compared with modern comprehensive management: results of a retrospective cohort study","volume":"59","author":"Farquhar","year":"2016","journal-title":"Can J Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib29","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1097\/TA.0000000000001330","article-title":"Rib fracture fixation in the 65 years and older population: a paradigm shift in management strategy at a Level I trauma center","volume":"82","author":"Fitzgerald","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib60","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1177\/000313481808400519","article-title":"Chest wall stabilization leads to shortened chest tube stay time in rib fracture patients after traumatic chest wall injury","volume":"84","author":"Fitzgerald","year":"2018","journal-title":"Am Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib61","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/BOT.0000000000001264","article-title":"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","volume":"33","author":"Gerakopoulos","year":"2019","journal-title":"J Orthop Trauma"},{"key":"10.1016\/j.jss.2022.02.055_bib62","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1510\/icvts.2005.111807","article-title":"Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status","volume":"4","author":"Granetzny","year":"2005","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib63","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2015\/624723","article-title":"Flail chest in Polytraumatized patients: surgical fixation using stracos reduces ventilator time and hospital stay","volume":"2015","author":"Jayle","year":"2015","journal-title":"Biomed Res Int"},{"key":"10.1016\/j.jss.2022.02.055_bib64","doi-asserted-by":"crossref","DOI":"10.1177\/0300060519877076","article-title":"A new instrument for surgical stabilization of multiple rib fractures","volume":"48","author":"Jian","year":"2020","journal-title":"J Int Med Res"},{"key":"10.1016\/j.jss.2022.02.055_bib65","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.jss.2019.04.005","article-title":"A randomized controlled trial of surgical rib fixation in polytrauma patients with flail chest","volume":"242","author":"Liu","year":"2019","journal-title":"J Surg Res"},{"key":"10.1016\/j.jss.2022.02.055_bib36","doi-asserted-by":"crossref","first-page":"439","DOI":"10.21037\/atm.2018.10.12","article-title":"Surgical versus conservative therapy for multiple rib fractures: a retrospective analysis","volume":"6","author":"Liu","year":"2018","journal-title":"Ann Transl Med"},{"key":"10.1016\/j.jss.2022.02.055_bib37","first-page":"576","article-title":"Rib fixation versus conservative management of rib fractures in trauma patients","volume":"30","author":"Majeed","year":"2018","journal-title":"J Ayub Med Coll Abbottabad"},{"key":"10.1016\/j.jss.2022.02.055_bib30","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1016\/j.jamcollsurg.2012.12.024","article-title":"Prospective randomized controlled trial of operative rib fixation in traumatic flail chest","volume":"216","author":"Marasco","year":"2013","journal-title":"J Am Coll Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib31","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.injury.2018.11.005","article-title":"Impact of rib fixation on quality of life after major trauma with multiple rib fractures","volume":"50","author":"Marasco","year":"2019","journal-title":"Injury"},{"key":"10.1016\/j.jss.2022.02.055_bib66","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1007\/s00068-013-0262-x","article-title":"Severe trauma of the chest wall: surgical rib stabilisation versus non-operative treatment","volume":"39","author":"Muhm","year":"2013","journal-title":"Eur J Trauma Emerg Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib38","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1007\/s12262-015-1409-2","article-title":"Potential benefits of rib fracture fixation in patients with flail chest and multiple non-flail rib fractures","volume":"78","author":"Qiu","year":"2016","journal-title":"Indian J Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib67","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1097\/TA.0000000000002358","article-title":"Effect of surgical rib fixation for rib fracture on mortality: a multicenter, propensity score matching analysis","volume":"87","author":"Shibahashi","year":"2019","journal-title":"J Trauma Acute Care Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib68","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1007\/s00068-016-0687-0","article-title":"Evaluation of efficacy and indications of surgical fixation for multiple rib fractures: a propensity-score matched analysis","volume":"43","author":"Uchida","year":"2017","journal-title":"Eur J Trauma Emerg Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib69","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1177\/000313481608200502","article-title":"Operative versus nonoperative management of multiple rib fractures","volume":"82","author":"Velasquez","year":"2016","journal-title":"Am Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib70","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1016\/j.jcrc.2015.07.027","article-title":"Effectiveness of surgical rib fixation on prolonged mechanical ventilation in patients with traumatic rib fractures: a propensity score-matched analysis","volume":"30","author":"Wada","year":"2015","journal-title":"J Crit Care"},{"key":"10.1016\/j.jss.2022.02.055_bib39","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/BOT.0000000000001344","article-title":"Surgical stabilization improves 30-day mortality in patients with traumatic flail chest: a comparative Case series at a major trauma center","volume":"33","author":"Walters","year":"2019","journal-title":"J Orthop Trauma"},{"key":"10.1016\/j.jss.2022.02.055_bib71","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1007\/s00068-018-0961-4","article-title":"Early results after operatively versus non-operatively treated flail chest: a retrospective study focusing on outcome and complications","volume":"46","author":"Wijffels","year":"2020","journal-title":"Eur J Trauma Emerg Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib32","first-page":"7930","article-title":"Which is better to multiple rib fractures, surgical treatment or conservative treatment?","volume":"8","author":"Wu","year":"2015","journal-title":"Int J Clin Exp Med"},{"key":"10.1016\/j.jss.2022.02.055_bib43","doi-asserted-by":"crossref","first-page":"216","DOI":"10.21037\/atm.2020.01.39","article-title":"Surgical fixation of rib fractures decreases intensive care length of stay in flail chest patients","volume":"8","author":"Xiao","year":"2020","journal-title":"Ann Transl Med"},{"key":"10.1016\/j.jss.2022.02.055_bib72","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s40001-015-0146-0","article-title":"Better short-term efficacy of treating severe flail chest with internal fixation surgery compared with conservative treatments","volume":"20","author":"Xu","year":"2015","journal-title":"Eur J Med Res"},{"key":"10.1016\/j.jss.2022.02.055_bib73","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/j.ajem.2015.04.005","article-title":"Comparison of surgical fixation and nonsurgical management of flail chest and pulmonary contusion","volume":"33","author":"Zhang","year":"2015","journal-title":"Am J Emerg Med"},{"key":"10.1016\/j.jss.2022.02.055_bib74","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1186\/s13019-015-0363-1","article-title":"Management of patients with flail chest by surgical fixation using claw-type titanium plate","volume":"10","author":"Zhang","year":"2015","journal-title":"J Cardiothorac Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib33","doi-asserted-by":"crossref","first-page":"3718","DOI":"10.12998\/wjcc.v7.i22.3718","article-title":"Surgical treatment of patients with severe non-flail chest rib fractures","volume":"7","author":"Zhang","year":"2019","journal-title":"World J Clin Cases"},{"key":"10.1016\/j.jss.2022.02.055_bib75","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1097\/TA.0000000000002666","article-title":"Rib fixation in geriatric trauma: mortality benefits for the most vulnerable patients","volume":"89","author":"Zhu","year":"2020","journal-title":"J Trauma Acute Care Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib34","doi-asserted-by":"crossref","first-page":"185","DOI":"10.5761\/atcs.oa.18-00295","article-title":"Comparison of the effectiveness of surgical versus nonsurgical treatment for multiple rib fractures accompanied with pulmonary contusion","volume":"25","author":"Jiang","year":"2019","journal-title":"Ann Thorac Cardiovasc Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib49","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1016\/j.jamcollsurg.2017.11.008","article-title":"Surgical stabilization of rib fractures: a single institution experience","volume":"226","author":"Kane","year":"2018","journal-title":"J Am Coll Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib35","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.ijsu.2011.06.003","article-title":"A prospective single center study to assess the impact of surgical stabilization in patients with rib fracture","volume":"9","author":"Khandelwal","year":"2011","journal-title":"Int J Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib40","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1177\/1460408619895683","article-title":"Multiple rib fractures: a novel and prognostic CT-based classification system","volume":"22","author":"Simpson","year":"2020","journal-title":"Trauma"},{"key":"10.1016\/j.jss.2022.02.055_bib41","series-title":"Chest Wall Injury Society Guideline For SSRF Indications, Contraindications and Timing","author":"Delaplain","year":"2021"},{"key":"10.1016\/j.jss.2022.02.055_bib42","doi-asserted-by":"crossref","first-page":"e40","DOI":"10.1097\/TA.0000000000002282","article-title":"Taxonomy of multiple rib fractures: results of the chest wall injury society international consensus survey","volume":"88","author":"Edwards","year":"2020","journal-title":"J Trauma Acute Care Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib45","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1177\/000313481908500523","article-title":"State of rib fracture care: a NTDB review of analgesic management and surgical stabilization","volume":"85","author":"Cheema","year":"2019","journal-title":"Am Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib46","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1007\/s00068-019-01119-z","article-title":"Mechanism of injury, injury patterns and associated injuries in patients operated for chest wall trauma","volume":"47","author":"Caragounis","year":"2021","journal-title":"Eur J Trauma Emerg Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib47","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/S1010-7940(03)00256-2","article-title":"A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management","volume":"24","author":"Sirmali","year":"2003","journal-title":"Eur J Cardiothorac Surg"},{"key":"10.1016\/j.jss.2022.02.055_bib48","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1002\/msj.21288","article-title":"Long-term outcomes in elderly surgical patients","volume":"79","author":"Deiner","year":"2012","journal-title":"Mt Sinai J Med"},{"key":"10.1016\/j.jss.2022.02.055_bib50","doi-asserted-by":"crossref","first-page":"2768","DOI":"10.21037\/jtd-21-111","article-title":"Prosthetic-free ribs stabilization technique in critical complex chest wall traumas: first results and experiences","volume":"13","author":"Girotti","year":"2021","journal-title":"J Thorac Dis"},{"key":"10.1016\/j.jss.2022.02.055_bib51","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.injury.2016.11.026","article-title":"Consensus statement: surgical stabilization of rib fractures rib fracture colloquium clinical practice guidelines","volume":"48","author":"Pieracci","year":"2017","journal-title":"Injury"},{"key":"10.1016\/j.jss.2022.02.055_bib52","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/TA.0000000000001729","article-title":"A multicenter evaluation of the optimal timing of surgical stabilization of rib fractures","volume":"84","author":"Pieracci","year":"2018","journal-title":"J Trauma Acute Care Surg"}],"container-title":["Journal of Surgical Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0022480422001378?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0022480422001378?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T14:57:59Z","timestamp":1758380279000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0022480422001378"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8]]},"references-count":76,"alternative-id":["S0022480422001378"],"URL":"https:\/\/doi.org\/10.1016\/j.jss.2022.02.055","relation":{},"ISSN":["0022-4804"],"issn-type":[{"value":"0022-4804","type":"print"}],"subject":[],"published":{"date-parts":[[2022,8]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Surgical Rib Fixation of Multiple Rib Fractures and Flail Chest: A Systematic Review and Meta-analysis","name":"articletitle","label":"Article Title"},{"value":"Journal of Surgical Research","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jss.2022.02.055","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"Crown Copyright \u00a9 2022 Published by Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}