{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T12:49:26Z","timestamp":1776948566170,"version":"3.51.4"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T00:00:00Z","timestamp":1678838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008127","name":"DePuy Synthes","doi-asserted-by":"publisher","award":["DPS-TCMF-2017-036"],"award-info":[{"award-number":["DPS-TCMF-2017-036"]}],"id":[{"id":"10.13039\/100008127","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Most studies about rib fractures focus on mortality and morbidity. Literature is scarce on long term and quality of life (QoL) outcomes. Therefore, we report QoL and long-term outcomes after rib fixation in flail chest patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A prospective cohort study of clinical flail chest patients admitted to six level 1 trauma centres in the Netherlands and Switzerland between January 2018 and March 2021. Outcomes included in-hospital outcomes and long-term outcomes, such as QoL measurements 12 months after hospitalization using the EuroQoL five dimensions (EQ-5D) questionnaire.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty-one operatively treated flail chest patients were included. Median hospital length of stay was 15 days and intensive care length of stay was 8 days. Sixteen (26%) patients developed pneumonia and two (3%) died. One year after hospitalization the mean EQ5D score was 0.78. Complication rates were low and included hemothorax (6%) pleural effusion (5%) and two revisions of the implant (3%). Implant related irritation was commonly reported by patients (<jats:italic>n<\/jats:italic>\u2009=\u200915, 25%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Rib fixation for flail chest injuries can be considered a safe procedure and with low mortality rates. Future studies should focus on quality of life rather than solely short-term outcomes.<\/jats:p><jats:p><jats:bold>Trial registration:<\/jats:bold> Registered in the Netherlands Trial Register NTR6833 on 13\/11\/2017 and the Swiss Ethics Committees Registration Number 2019-00668<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2023.1156489","type":"journal-article","created":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T04:58:30Z","timestamp":1678856310000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Quality of life and clinical outcomes of operatively treated patients with flail chest injuries: A multicentre prospective cohort study"],"prefix":"10.3389","volume":"10","author":[{"given":"Ruben J.","family":"Hoepelman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrizio","family":"Minervini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank J. P.","family":"Beeres","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bas","family":"van Wageningen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank F.","family":"IJpma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole M.","family":"van Veelen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koen W. W.","family":"Lansink","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jochem M.","family":"Hoogendoorn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark. C. P.","family":"van Baal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rolf H. H.","family":"Groenwold","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roderick M.","family":"Houwert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"on behalf of the NEXT study group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,3,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e000441","DOI":"10.1136\/tsaco-2020-000441","article-title":"Traumatic rib fractures: a marker of severe injury. A nationwide study using the national trauma data bank","volume":"5","author":"Peek","year":"2020","journal-title":"Trauma Surg Acute Care Open"},{"key":"B2","doi-asserted-by":"publisher","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":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-022-02152-1","article-title":"Flail chest injury\u2014changing management and outcomes","author":"Marasco","year":"2022","journal-title":"Eur J Trauma Emerg Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1097\/TA.0000000000003549","article-title":"Rib fixation in non-ventilator-dependent chest wall injuries: a prospective randomized trial","volume":"92","author":"Marasco","year":"2022","journal-title":"J Trauma Acute Care Surg"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-022-02093-9","article-title":"Non-operative vs. Operative treatment for multiple rib fractures after blunt thoracic trauma: a multicenter prospective cohort study","volume":"49","author":"Hoepelman","year":"2022","journal-title":"Eur J Trauma Emerg Surg"},{"key":"B6","doi-asserted-by":"publisher","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":"B7","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.injury.2020.09.018","article-title":"Plates versus struts versus an extracortical rib fixation in flail chest patients: two-center experience","volume":"52","author":"Divisi","year":"2021","journal-title":"Injury"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/TA.0000000000001729","article-title":"A multicenter evaluation of the optimal timing of surgical stabilization of rib fractures","author":"Pieracci","year":"2018","journal-title":"J Trauma Acute Care Surg"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-200006000-00007","article-title":"Rib fractures in the elderly","author":"Bulger","year":"2000"},{"key":"B10","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1007\/s00068-019-01273-4","article-title":"The evolution of trauma care in The Netherlands over 20 years","volume":"46","author":"Hietbrink","year":"2020","journal-title":"Eur J Trauma Emerg Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2731","DOI":"10.1007\/s11136-019-02211-y","article-title":"Routine incorporation of longer-term patient-reported outcomes into a Dutch trauma registry","volume":"28","author":"van der Vliet","year":"2019","journal-title":"Qual Life Res"},{"key":"B12","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"335","author":"von Elm","year":"2007","journal-title":"Br Med J"},{"key":"B13","volume-title":"Abbreviated injury scale: 2015 revision","year":"2018"},{"key":"B14","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1097\/ALN.0000000000001541","article-title":"ASA Provides examples to each ASA physical Status class","volume":"79","author":"Abouleish","year":"2015","journal-title":"ASA Newsl"},{"key":"B15","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1097\/00005373-198704000-00005","article-title":"Evaluating trauma care: the TRISS method. Trauma score and the injury severity score","volume":"27","author":"Boyd","year":"1987","journal-title":"J Trauma"},{"key":"B16","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1016\/j.injury.2017.08.040","article-title":"Fracture-related infection: a consensus on definition from an international expert group","volume":"49","author":"Metsemakers","year":"2018","journal-title":"Injury"},{"key":"B17","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1007\/s11999-016-5113-8","article-title":"High irritation and removal rates after plate or nail fixation in patients with displaced midshaft clavicle fractures","volume":"475","author":"Hulsmans","year":"2017","journal-title":"Clin Orthop Relat Res"},{"key":"B18","doi-asserted-by":"publisher","first-page":"2526","DOI":"10.1001\/jama.2012.5669","article-title":"Acute respiratory distress syndrome: the Berlin definition","volume":"307","author":"Ranieri","year":"2012","journal-title":"JAMA"},{"key":"B19","doi-asserted-by":"publisher","first-page":"337","DOI":"10.3109\/07853890109002087","article-title":"EQ-5D: a measure of health status from the EuroQol group","volume":"33","author":"Rabin","year":"2001","journal-title":"Ann Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"00084","DOI":"10.1183\/23120541.00084-2017","article-title":"mMRC dyspnoea scale indicates impaired quality of life and increased pain in patients with idiopathic pulmonary fibrosis","volume":"3","author":"Rajala","year":"2017","journal-title":"ERJ Open Res"},{"key":"B21","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1016\/j.jval.2016.01.003","article-title":"Dutch Tariff for the five-level version of EQ-5D","volume":"19","author":"Versteegh","year":"2016","journal-title":"Value Health"},{"key":"B22","doi-asserted-by":"publisher","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":"B23","doi-asserted-by":"publisher","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":"JTrauma Acute Care Surg"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2022.4299","article-title":"Operative vs nonoperative treatment of acute unstable chest wall injuries","author":"Dehghan","year":"2022","journal-title":"JAMA Surg"},{"key":"B25","doi-asserted-by":"publisher","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":"B26","doi-asserted-by":"publisher","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":"B27","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-20020400-00020","article-title":"Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients","author":"Tanaka","year":"2002"},{"key":"B28","doi-asserted-by":"publisher","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":"B29","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-016-0085-2","article-title":"Surgical treatment of multiple rib fractures and flail chest in trauma: a one-year follow-up study","volume":"11","author":"Caragounis","year":"2016","journal-title":"World J Emerg Surg"},{"key":"B30","doi-asserted-by":"crossref","DOI":"10.1007\/978-94-007-7596-1","volume-title":"Self-Reported population health: An international perspective based on EQ-5D","author":"Szende","year":"2014"},{"key":"B31","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1097\/TA.0000000000002716","article-title":"Complications and outcome after rib fracture fixation: a systematic review","volume":"89","author":"Peek","year":"2020","journal-title":"J Trauma Acute Care Surg"},{"key":"B32","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1007\/s00068-018-1009-5","article-title":"Long-term follow-up after rib fixation for flail chest and multiple rib fractures","volume":"45","author":"Beks","year":"2019","journal-title":"Eur J Trauma Emerg Surg"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e000546","DOI":"10.1136\/tsaco-2020-000546","article-title":"Long-term outcomes of surgical rib fixation in patients with flail chest and multiple rib fractures","volume":"5","author":"Uchida","year":"2020","journal-title":"Trauma Surg Acute Care Open"},{"key":"B34","doi-asserted-by":"publisher","first-page":"490","DOI":"10.21037\/jtd.2016.02.64","article-title":"Chest wall stabilization and reconstruction: short and long-term results 5 years after the introduction of a new titanium plates system","volume":"8","author":"De Palma","year":"","journal-title":"J Thorac Dis"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2023.1156489\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T04:58:34Z","timestamp":1678856314000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2023.1156489\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,15]]},"references-count":34,"alternative-id":["10.3389\/fsurg.2023.1156489"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2023.1156489","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,15]]},"article-number":"1156489"}}