SynthesisBMJ open2019
Systematic review of systematic reviews for effectiveness of internal fixation for flail chest and rib fractures in adults.
Synthesis in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04548466 (Effect of Positive Expiratory Pressure on the Management of Chest Trauma), which is not on this map. Cited by 18 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Effect of Positive Expiratory Pressure on the Management of Chest Trauma: a Randomized Controlled Trial
Who cites it
18 citing papers in PubMed, 3 syntheses or guidelines pooled it, 52 citations in OpenAlex.
- Critically Ill Older Adults' Representation in Intervention Trials: A Systematic Review.Critical care explorations · 2024Pooled it
- A meta-analysis and trial sequential analysis of randomised controlled trials comparing nonoperative and operative management of chest trauma with multiple rib fractures.World journal of emergency surgery : WJES · 2024Pooled it
- Surgical management of rib fractures after blunt trauma: a systematic review and meta-analysis of randomised controlled trials.Annals of the Royal College of Surgeons of England · 2022Pooled it
- The effectiveness of early surgical stabilization for multiple rib fractures: a multicenter randomized controlled trial.Journal of cardiothoracic surgery · 2023Trial
- An Overview of Meta-Analyses on the Surgical Stabilization of Rib Fractures in Adults: A Narrative Umbrella Review (2020-2025).Journal of clinical medicine · 2026Review
- Multivariate analysis of the effectiveness of the surgical treatment of the non-flail chest type of multiple rib fractures.Experimental and therapeutic medicine · 2025Article
- Impact of Surgical Stabilization of Flail Chest Injuries on Postoperative Computed Tomography Lung Volumes.Journal of clinical medicine · 2025Article
- Surgical rib fixation in patients with cardiopulmonary disease improves outcomes.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Article
- Comparative study of wound outcomes and surgical strategies: Internal fixation versus external stabilization in rib fracture patients with traumatic chest wounds.International wound journal · 2024Article
- Synthesising results of meta-analyses to inform policy: a comparison of fast-track methods.Environmental evidence · 2023Article
- Predictors of long-term survival in 5,680 patients admitted to a UK major trauma centre with thoracic injuries.Annals of the Royal College of Surgeons of England · 2023Article
- Management Pathways for Traumatic Rib Fractures-Importance of Surgical Stabilisation.Healthcare (Basel, Switzerland) · 2023Article
- Flail chest injury-changing management and outcomes.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2023Article
- Effect of surgical stabilization of rib fractures in polytrauma: an analysis of the TraumaRegister DGUEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022Article
- Chest Compression-Related Flail Chest Is Associated with Prolonged Ventilator Weaning in Cardiac Arrest Survivors.Journal of clinical medicine · 2022Article
- Impact of Time of Surgery on the Outcome after Surgical Stabilization of Rib Fractures in Severely Injured Patients with Severe Chest Trauma-A Matched-Pairs Analysis of the German Trauma Registry.Frontiers in surgery · 2022Article
- Complications of clavicle fracture surgery in patients with concomitant chest wall injury: a retrospective study.BMC musculoskeletal disorders · 2021Article
- A narrative review of traumatic mediastinal injuries and their management: the thoracic surgeon perspective.Mediastinum (Hong Kong, China) · 2021Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesMultiple systematic reviews have reported on the impact of rib fracture fixation in the presence of flail chest and multiple rib fractures, however this practice remains controversial. Our aim is to synthesise the effectiveness of surgical rib fracture fixation as evidenced by systematic reviews.
designA systematic search identified systematic reviews comparing effectiveness of rib fracture fixation with non-operative management of adults with flail chest or unifocal non-flail rib fractures. MEDLINE, EMBASE, Cochrane Database of Systematic Reviews and Science Citation Index were last searched 17 March 2017. Risk of bias was assessed using the Risk Of Bias In Systematic reviews (ROBIS) tool. The primary outcome was duration of mechanical ventilation.
resultsTwelve systematic reviews were included, consisting of 3 unique randomised controlled trials and 19 non-randomised studies. Length of mechanical ventilation was shorter in the fixation group compared with the non-operative group in flail chest; pooled estimates ranged from -4.52 days, 95% CI (-5.54 to -3.5) to -7.5 days, 95% CI (-9.9 to -5.5). Pneumonia, length of hospital and intensive care unit stay all showed a statistically significant improvement in favour of fixation for flail chest; however, all outcomes in favour of fixation had substantial heterogeneity. There was no statistically significant difference between groups in mortality. Two systematic reviews included one non-randomised studies of unifocal non-flail rib fracture population; due to limited evidence the benefits with surgery are uncertain.
conclusionsSynthesis of the reviews has shown some potential improvement in patient outcomes with flail chest after fixation. For future review updates, meta-analysis for effectiveness may need to take into account indications and timing of surgery as a subgroup analysis to address clinical heterogeneity between primary studies. Further robust evidence is required before conclusions can be drawn of the effectiveness of surgical fixation for flail chest and in particular, unifocal non-flail rib fractures. PROSPERO REGISTRATION NUMBER: CRD42016053494.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.