{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T06:20:44Z","timestamp":1783405244708,"version":"3.54.6"},"reference-count":69,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p>Chest wall injury impairs ventilation not only through pain, but also through loss of thoracic cage stability and disruption of regional mechanics. As surgical stabilization of rib fractures continues to expand, variability in operative technique and construct design remains, while recurring complication patterns suggest that mismatch between fixation constructs and physiologic loading may represent an underrecognized and potentially preventable cause of failure. Drawing on clinical guidelines, experimental biomechanics, advanced imaging, and contemporary finite-element modeling, this review synthesizes the mechanical behavior of the thoracic cage across the ribs, costochondral junctions, and sternum, and translates these principles into surgical planning. We propose a mechanics-based framework that links specific instability patterns to functional impairment and informs construct selection, including operative approach, plate and screw strategy, bone quality considerations, and management of sternal and costal cartilage involvement. In addition, we summarize common modes of fixation failure and discuss practical strategies to reduce their occurrence.<\/jats:p>","DOI":"10.3389\/fsurg.2026.1841068","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T05:46:20Z","timestamp":1783403180000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Biomechanics of chest wall injury: implications for surgical stabilization and failure prevention"],"prefix":"10.3389","volume":"13","author":[{"given":"Vladislav","family":"Muldiiarov","sequence":"first","affiliation":[{"name":"St. Joseph\u2019s Hospital and Medical Center, Norton Thoracic Institute","place":["Phoenix, AZ, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary M.","family":"Bauman","sequence":"additional","affiliation":[{"name":"Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center","place":["Omaha, NE, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1510\/icvts.2009.206599","article-title":"Comprehensive analysis of 4205 patients with chest trauma: a 10-year experience","volume":"9","author":"Demirhan","year":"2009","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"B2","doi-asserted-by":"publisher","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":"B3","doi-asserted-by":"publisher","first-page":"82211","DOI":"10.56305\/001c.82211","article-title":"Rib fracture management in older adults: a scoping review","volume":"2","author":"Qureshi","year":"2023","journal-title":"J Brown Hosp Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"R98","DOI":"10.1186\/cc13873","article-title":"Predicting outcomes after blunt chest wall trauma: development and external validation of a new prognostic model","volume":"18","author":"Battle","year":"2014","journal-title":"Crit Care"},{"key":"B5","doi-asserted-by":"publisher","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":"B6","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1016\/j.injury.2007.10.021","article-title":"Failed emergency department disposition to the ward of patients with thoracic injury","volume":"39","author":"Blecher","year":"2008","journal-title":"Injury"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e267","DOI":"10.1016\/j.athoracsur.2018.08.076","article-title":"Fracture of the costal cartilage: presentation, diagnosis, and management","volume":"107","author":"Sollender","year":"2019","journal-title":"Ann Thorac Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/s13017-024-00559-2","article-title":"Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper","volume":"19","author":"Sermonesi","year":"2024","journal-title":"World J Emerg Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1097\/00005373-200204000-00020","article-title":"Surgical stabilization of internal pneumatic stabilization? 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