{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:44:57Z","timestamp":1787755497857,"version":"build-2784847793"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,5,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>A previous randomized controlled trial (RCT) evaluating operative versus nonoperative treatment of acute flail chest injuries revealed more ventilator-free days in operatively treated patients who had been ventilated at the time of randomization. It has been suggested that surgery for these injuries may also improve a patient\u2019s pain and function. Our goal was to perform a secondary analysis of the previous RCT to evaluate pain and postinjury opioid requirements in patients with operatively and nonoperatively treated unstable chest wall injuries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We analyzed data from a previous multicenter RCT that had been conducted from 2011 to 2019. Patients who had sustained acute, unstable chest wall injuries were randomized to operative or nonoperative treatment. In-hospital pain medication logs were evaluated, and daily morphine milligram equivalents (MMEs) were calculated. The patients\u2019 symptoms were also assessed, including generalized pain, chest wall pain, chest wall tightness, and shortness of breath. Additionally, patients completed the 36-Item Short Form Health Survey (SF-36), and they were followed for 1 year postinjury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In the original trial, 207 patients were analyzed: 99 patients received nonoperative treatment, and 108 received operative treatment. There were no significant differences in pain medication usage between the 2 groups at any of the examined time points (p = 0.477). There were no significant differences in generalized pain, chest wall pain, chest wall tightness, or shortness of breath at any time postinjury in the 2 groups. There were also no significant differences in the SF-36 scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This secondary analysis of a previous RCT suggested that operative treatment of patients with flail chest injuries does not reduce in-hospital daily opioid requirements. There were also no reductions in generalized pain, chest wall pain, chest wall tightness, or shortness of breath with operative treatment. The SF-36 scores were similar for both groups. Further work is needed to identify those patients most likely to benefit from operative treatment of flail chest injuries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level I<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.24.01099","type":"journal-article","created":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T14:00:48Z","timestamp":1741356048000},"page":"928-935","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Operative Treatment of Flail Chest Injuries Does Not Reduce Pain or In-Hospital Opioid Requirements"],"prefix":"10.2106","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5180-4311","authenticated-orcid":false,"given":"Niloofar","family":"Dehghan","sequence":"first","affiliation":[{"name":"The CORE Institute, Phoenix, Arizona"},{"name":"University of Arizona College of Medicine Phoenix, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1839-0209","authenticated-orcid":false,"given":"Jessica","family":"McGraw-Heinrich","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1230-2248","authenticated-orcid":false,"given":"Christine","family":"Schemitsch","sequence":"additional","affiliation":[{"name":"St. Michael\u2019s Hospital, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9186-7747","authenticated-orcid":false,"given":"Aaron","family":"Nauth","sequence":"additional","affiliation":[{"name":"St. Michael\u2019s Hospital, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2829-6665","authenticated-orcid":false,"given":"Jennifer","family":"Hidy","sequence":"additional","affiliation":[{"name":"St. Michael\u2019s Hospital, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9280-8039","authenticated-orcid":false,"given":"Milena","family":"Vicente","sequence":"additional","affiliation":[{"name":"St. Michael\u2019s Hospital, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6435-9069","authenticated-orcid":false,"given":"Emil H.","family":"Schemitsch","sequence":"additional","affiliation":[{"name":"University of Western Ontario, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1589-9632","authenticated-orcid":false,"given":"Richard","family":"Jenkinson","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9406-5232","authenticated-orcid":false,"given":"Hans","family":"Kreder","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4306-4090","authenticated-orcid":false,"given":"Michael D.","family":"McKee","sequence":"additional","affiliation":[{"name":"University of Arizona College of Medicine Phoenix, Phoenix, Arizona"},{"name":"Banner University Medical Center, Phoenix Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Canadian Orthopaedic Trauma Society","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Unstable Chest Wall RCT Study Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,3,7]]},"reference":[{"issue":"1","key":"bib1-20250509","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/01.TA.0000063612.25756.60","article-title":"Operative chest wall fixation with osteosynthesis plates","volume":"58","author":"Engel","year":"2005","journal-title":"J Trauma."},{"issue":"1","key":"bib2-20250509","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1007\/s00268-008-9770-y","article-title":"Rib fracture repair: indications, technical issues, and future directions","volume":"33","author":"Nirula","year":"2009","journal-title":"World J Surg."},{"issue":"6","key":"bib3-20250509","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1510\/icvts.2005.111807","article-title":"Surgical versus conservative treatment of flail chest. 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