{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T06:11:59Z","timestamp":1792735919850,"version":"4.5.0"},"reference-count":30,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"8","license":[{"start":{"date-parts":[[2016,8,1]],"date-time":"2016-08-01T00:00:00Z","timestamp":1470009600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":["online.boneandjoint.org.uk"],"crossmark-restriction":true},"short-container-title":["The Bone &amp; Joint Journal"],"published-print":{"date-parts":[[2016,8]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p> Flail chest from a blunt injury to the thorax is associated with significant morbidity and mortality. Its management globally is predominantly non-operative; however, there are an increasing number of centres which undertake surgical stabilisation. The aim of this meta-analysis was to compare the efficacy of this approach with that of non-operative management. <\/jats:p><\/jats:sec><jats:sec><jats:title\/><jats:p> A systematic search of the literature was carried out to identify randomised controlled trials (RCTs) which compared the clinical outcome of patients with a traumatic flail chest treated by surgical stabilisation of any kind with that of non-operative management. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> Of 1273 papers identified, three RCTs reported the results of 123 patients with a flail chest. Surgical stabilisation was associated with a two thirds reduction in the incidence of pneumonia when compared with non-operative management (risk ratio 0.36, 95% confidence interval (CI) 0.15 to 0.85, p = 0.02). The duration of mechanical ventilation (mean difference -6.30 days, 95% CI -12.16 to -0.43, p = 0.04) and length of stay in an intensive care unit (mean difference -6.46 days, 95% CI 9.73 to -3.19, p = 0.0001) were significantly shorter in the operative group, as was the overall length of stay in hospital (mean difference -11.39, 95% CI -12.39 to -10.38, p &lt; 0.0001). <\/jats:p><\/jats:sec><jats:sec><jats:title\/><jats:p> Surgical stabilisation for a traumatic flail chest is associated with significant clinical benefits in this meta-analysis of three relatively small RCTs. Cite this article: Bone Joint J 2016;98-B:1119\u201325. <\/jats:p><\/jats:sec>","DOI":"10.1302\/0301-620x.98b8.37282","type":"journal-article","created":{"date-parts":[[2016,8,1]],"date-time":"2016-08-01T12:13:09Z","timestamp":1470053589000},"page":"1119-1125","update-policy":"https:\/\/doi.org\/10.1302\/crossmark-policy","source":"Crossref","is-referenced-by-count":86,"title":["Management of rib fractures in traumatic flail chest"],"prefix":"10.1302","volume":"98-B","author":[{"given":"T. A.","family":"Coughlin","sequence":"first","affiliation":[{"name":"Queen\u2019s Medical Centre, Nottingham\rUniversity Hospitals NHS Trust, Derby Road, Nottingham, NG7\r2UH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. W. G.","family":"Ng","sequence":"additional","affiliation":[{"name":"Queen\u2019s Medical Centre, Nottingham\rUniversity Hospitals NHS Trust, Derby Road, Nottingham, NG7\r2UH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. 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