Abstract Introduction The objective of this study is to compare the outcomes of patients with flail chest or multiple rib injuries undergoing surgical rib fixation versus conservative management. Methods Standard medical databases such as MEDLINE, Embase, Pubmed, and Cochrane Library were searched to find randomized controlled trials comparing outcomes of patients with flail chest or multiple rib fractures who were managed surgically by rib fixation versus conservatively. All data were analyzed using Review Manager Software 5.4, and the meta-analysis was performed with a random effect model analysis. Results A total of 9 randomized, control trials were included (n=862) recruiting patients with flail chest or multiple rib fractures to be treated with surgical or conservative intervention. In the random effect model analysis, surgical intervention was shown to reduce length of intensive care unit (ICU) stay (Standard mean difference (SMD): -0.91, 95% confidence interval (CI): -1.52, -0.29, Z=2.89, P=0.004), days of ventilation (SMD: -1.42, 95% CI: -2.25, -0.59, Z=3.36, P=0.0008), and postoperative pneumonia incidence (Risk ratio (RR): 0.59, 95% CI: 0.37, 0.92, Z=2.31, P=0.02). Length of hospital stay (SMD: -0.38, 95% CI: -1.15, 0.38, Z=0.98, P=0.33), the number of patients needing a tracheostomy (RR:0.79, 95% CI: 0.44,1.43, Z=0.79, P=0.43), and mortality (RR:0.9, 95% CI: 0.35,2.26, Z=0.23, P=0.81) however, were found to be not statistically significant. Conclusion Rib fixation for patients with multiple rib fractures or flail chest was associated with reduced risk of chest infections, shorter length of ICU stay, and shorter ventilation duration.
Lubbad et al. (Fri,) studied this question.