Trial reportAnnals of surgery2023
Randomized Controlled Trial of Surgical Rib Fixation to Nonoperative Management in Severe Chest Wall Injury.
Trial report in Annals of surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 3 syntheses or guidelines pooled it, 47 citations in OpenAlex.
- Comparison of flail and multiple simple rib fracture patterns among patients included in rib fracture studies; A systematic review and meta-analysis.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Pooled it
- Clinical outcome analysis for surgical fixation versus conservative treatment on rib fractures: a systematic evaluation and meta-analysis.World journal of emergency surgery : WJES · 2025Pooled 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 stabilization of rib fractures in a high-altitude trauma cohort: in-hospital clinical outcomes and resource use in a propensity score-weighted retrospective cohort study.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- From rib fixation to dynamic chest wall reconstruction: historical lessons for modern surgical stabilization of rib fractures.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Review
- ARDS management in trauma patients.Intensive care medicine · 2026Review
- Surgical stabilization of rib fractures is associated with lower adjusted odds of adverse pulmonary outcomes across RibScore-defined injury severity: a single-center cohort study.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- Surgical stabilization of rib fractures in older adults: a retrospective cohort study.Updates in surgery · 2026Article
- Application of virtual overlapping technology for the selection of appropriate metal plate dimensions in rib fracture surgery.Quantitative imaging in medicine and surgery · 2026Article
- Quality of rib fracture-related video information on TikTok and Bilibili: a cross-sectional study.Journal of thoracic disease · 2026Article
- Long-term quality of life and chronic pain after surgical vs. non-operative treatment of rib fractures: systematic review and meta-analysis.Frontiers in surgery · 2026Review
- Contemporary and Future Perspectives on Thoracic Trauma Care: Surgical Stabilization, Multidisciplinary Approaches, and the Role of Artificial Intelligence.Journal of clinical medicine · 2025Article
- Two-center retrospective study comparing intramedullary and plate fixation for rib fractures on safety and cost-effectiveness.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Article
- RibMR - A Mixed Reality Visualization System for Rib Fracture Localization in Surgical Stabilization of Rib Fractures: Phantom, Preclinical, and Clinical Studies.Journal of imaging informatics in medicine · 2025Article
- To fix or let them flail: the who, what and when of rib fixation.Trauma surgery & acute care open · 2025Review
- Is fixation of a single end of flail segment rib fractures enough?Trauma surgery & acute care open · 2025Article
- Factors influencing Vizient length of stay index after surgical stabilization of rib fractures (SSRF).Trauma surgery & acute care open · 2025Article
- Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper.World journal of emergency surgery : WJES · 2024Review
- Treatment of traumatic rib fractures: an overview of current evidence and future perspectives.Journal of thoracic disease · 2024Review
- Comment on: "Randomized Controlled Trial of Surgical Rib Fixation to Nonoperative Management in Severe Chest Wall Injury".Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2024Article
Corrections and comments
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Authors and funding
10 authors at 1 institution in 1 country.
Funding
Abstract
objectiveTo compare the effectiveness of surgical stabilization of rib fractures (SSRFs) to nonoperative management in severe chest wall injury.
backgroundSSRF has been shown to improve outcomes in patients with clinical flail chest and respiratory failure. However, the effect of SSRF outcomes in severe chest wall injuries without clinical flail chest is unknown.
methodsRandomized controlled trial comparing SSRF to nonoperative management in severe chest wall injury, defined as: (1) a radiographic flail segment without clinical flail or (2) ≥5 consecutive rib fractures or (3) any rib fracture with bicortical displacement. Randomization was stratified by the unit of admission as a proxy for injury severity. Primary outcome was hospital length of stay (LOS). Secondary outcomes included intensive care unit (ICU) LOS, ventilator days, opioid exposure, mortality, and incidences of pneumonia and tracheostomy. Quality of life at 1, 3, and 6 months was measured using the EQ-5D-5L survey.
resultsEighty-four patients were randomized in an intention-to-treat analysis (usual care = 42, SSRF = 42). Baseline characteristics were similar between groups. The numbers of total fractures, displaced fractures, and segmental fractures per patient were also similar, as were the incidences of displaced fractures and radiographic flail segments. Hospital LOS was greater in the SSRF group. ICU LOS and ventilator days were similar. After adjusting for the stratification variable, hospital LOS remained greater in the SSRF group (RR: 1.48, 95% CI: 1.17-1.88). ICU LOS (RR: 1.65, 95% CI: 0.94-2.92) and ventilator days (RR: 1.49, 95% CI: 0.61--3.69) remained similar. Subgroup analysis showed that patients with displaced fractures were more likely to have LOS outcomes similar to their usual care counterparts. At 1 month, SSRF patients had greater impairment in mobility [3 (2-3) vs 2 (1-2), P = 0.012] and self-care [2 (1-2) vs 2 (2-3), P = 0.034] dimensions of the EQ-5D-5L.
conclusionsIn severe chest wall injury, even in the absence of clinical flail chest, the majority of patients still reported moderate to extreme pain and impairment of usual physical activity at one month. SSRF increased hospital LOS and did not provide any quality of life benefit for up to 6 months.
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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.