{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T05:12:51Z","timestamp":1778562771237,"version":"3.51.4"},"reference-count":21,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T00:00:00Z","timestamp":1778284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"crossref","award":["RC2026 325\/01"],"award-info":[{"award-number":["RC2026 325\/01"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Italian Ministry of Education and Research"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Rib fractures are a common cause of morbidity in trauma patients. The surgical stabilization of rib fractures (SSRF) has gained increasing attention as a therapeutic option; however, evidence from multiple meta-analyses remains heterogeneous. Methods: We performed an overview of 11 meta-analyses, including a total of 1,117,849 adult patients (narrative umbrella review), published between November 2020 and November 2025 to summarize and critically appraise high-level evidence comparing SSRF with non-operative management (NOM) in adults with traumatic rib fractures. PubMed (MEDLINE) and Embase were searched for eligible meta-analyses. Outcomes of interest included mechanical ventilation duration, pneumonia, ICU and hospital length of stay, mortality, pain, quality of life, and need for tracheostomy. Results: Eleven meta-analyses met the inclusion criteria. Across outcomes, the direction of effect generally favored SSRF in selected patients, particularly with respect to a shorter duration of mechanical ventilation (mean difference up to approximately 4\u20136 days), reduced pulmonary complications (risk ratio approximately 0.4\u20130.7), shorter ICU and hospital stay, and improved pain control. However, results varied substantially across studies. A consistent mortality benefit was not observed. Subgroup analyses suggested that the benefits of SSRF were more pronounced in patients with flail chest, severe fracture patterns, and early surgery, whereas findings were less consistent in elderly patients and in patients with less severe injuries. Conclusions: This narrative umbrella review suggests that SSRF is associated with improved short-term outcomes in selected adult patients with traumatic rib fractures but should not be considered a universal standard of care. Careful patient selection, timing of intervention, and multidisciplinary evaluation remain essential. Further high-quality prospective studies are needed to better define optimal indications and management strategies.<\/jats:p>","DOI":"10.3390\/jcm15103648","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T17:17:42Z","timestamp":1778519862000},"page":"3648","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An Overview of Meta-Analyses on the Surgical Stabilization of Rib Fractures in Adults: A Narrative Umbrella Review (2020\u20132025)"],"prefix":"10.3390","volume":"15","author":[{"given":"Maria Chiara","family":"Sibilia","sequence":"first","affiliation":[{"name":"Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy"},{"name":"Department of Cardio-Thoraco-Vascular Diseases, Foundation IRCCS Ca\u2019 Granda\u2014Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Romboni","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy"},{"name":"Department of Cardio-Thoraco-Vascular Diseases, Foundation IRCCS Ca\u2019 Granda\u2014Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1767-3431","authenticated-orcid":false,"given":"Sara","family":"Franzi","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoraco-Vascular Diseases, Foundation IRCCS Ca\u2019 Granda\u2014Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenzo","family":"Bramati","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoraco-Vascular Diseases, ASST Brianza\u2014Ospedale di Vimercate, 20871 Vimercate, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Carmela","family":"Andrisani","sequence":"additional","affiliation":[{"name":"Radiology Department, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8571-121X","authenticated-orcid":false,"given":"Mario","family":"Nosotti","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy"},{"name":"Department of Cardio-Thoraco-Vascular Diseases, Foundation IRCCS Ca\u2019 Granda\u2014Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davide","family":"Tosi","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences and Integrated Diagnostics (DISC), School of Medical and Pharmaceutical Sciences, University of Genoa, 16132 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5399","DOI":"10.21037\/jtd-23-1832","article-title":"Treatment of traumatic rib fractures: An overview of current evidence and future perspectives","volume":"16","author":"Franssen","year":"2024","journal-title":"J. Thorac. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e023444","DOI":"10.1136\/bmjopen-2018-023444","article-title":"Systematic review of systematic reviews for effectiveness of internal fixation for flail chest and rib fractures in adults","volume":"9","author":"Ingoe","year":"2019","journal-title":"BMJ Open"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s13017-025-00581-y","article-title":"Clinical outcome analysis for surgical fixation versus conservative treatment on rib fractures: A systematic evaluation and meta-analysis","volume":"20","author":"Zhao","year":"2025","journal-title":"World J. Emerg. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.suc.2023.09.007","article-title":"Management of Blunt Chest Trauma","volume":"104","author":"Griffard","year":"2024","journal-title":"Surg. Clin. N. Am."},{"key":"ref_5","first-page":"33","article-title":"Surgical fixation of severe rib fractures: A systematic literature review and meta-analysis","volume":"3","author":"Shiroff","year":"2022","journal-title":"Arch. Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., Shamseer, L., Tetzlaff, J.M., Akl, E.A., and Brennan, S.E. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372.","DOI":"10.1136\/bmj.n71"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2368","DOI":"10.1016\/j.injury.2020.07.009","article-title":"Operative versus nonoperative treatment of multiple simple rib fractures: A systematic review and meta-analysis","volume":"51","author":"Wijffels","year":"2020","journal-title":"Injury"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13017-024-00540-z","article-title":"A meta-analysis and trial sequential analysis of randomised controlled trials comparing nonoperative and operative management of chest trauma with multiple rib fractures","volume":"19","author":"Hisamune","year":"2024","journal-title":"World J. Emerg. Surg."},{"key":"ref_9","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":"ref_10","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1007\/s00068-021-01606-2","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","volume":"48","author":"Apampa","year":"2022","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_11","first-page":"249","article-title":"Surgical management of rib fractures after blunt trauma: A systematic review and meta-analysis of randomised controlled trials","volume":"104","author":"Craxford","year":"2022","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.jss.2022.02.055","article-title":"Surgical Rib Fixation of Multiple Rib Fractures and Flail Chest: A Systematic Review and Meta-analysis","volume":"276","author":"Sawyer","year":"2022","journal-title":"J. Surg. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"111705","DOI":"10.1016\/j.injury.2024.111705","article-title":"Surgical stabilisation of rib fractures: A meta-analysis of randomised controlled trials","volume":"55","author":"Sharma","year":"2024","journal-title":"Injury"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4961","DOI":"10.21037\/jtd-23-1117","article-title":"Surgical stabilization of multiple rib fractures in an Asian population: A systematic review and meta-analysis","volume":"15","author":"He","year":"2023","journal-title":"J. Thorac. Dis."},{"key":"ref_15","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":"ref_16","doi-asserted-by":"crossref","first-page":"2531","DOI":"10.1007\/s00068-023-02339-0","article-title":"Surgical versus non-surgical treatment of flail chest: A meta-analysis of randomized controlled trials","volume":"49","author":"Pasqualotto","year":"2023","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e0032","DOI":"10.2106\/JBJS.ST.19.00032","article-title":"Surgical Stabilization of Rib Fractures: Indications, Techniques, and Pitfalls","volume":"10","author":"Fokin","year":"2020","journal-title":"JBJS Essent. Surg. Tech."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s13017-025-00620-8","article-title":"Clinical outcomes of rib fracture stabilization and conservative treatment in a high-volume Asian trauma center: A propensity score-matched retrospective study","volume":"20","author":"Kao","year":"2025","journal-title":"World J. Emerg. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","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":"ref_20","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":"ref_21","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.thorsurg.2025.12.004","article-title":"A Contemporary Review of Operative Indications for Chest Wall Trauma","volume":"36","author":"Ramsuchit","year":"2026","journal-title":"Thorac. Surg. Clin."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3648\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T04:38:50Z","timestamp":1778560730000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3648"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,9]]},"references-count":21,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15103648"],"URL":"https:\/\/doi.org\/10.3390\/jcm15103648","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,9]]}}}