Evidence map›Paper›PMID 39425134›Full record

ReviewWorld journal of emergency surgery : WJES2024

Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper.

Giacomo Sermonesi, Riccardo Bertelli, Fredric M Pieracci, Zsolt J Balogh, Raul Coimbra, Joseph M Galante, Andreas Hecker, Dieter Weber, Zachary M Bauman, Susan Kartiko and 52 more

Erratum issued 3 registry-linked trialsAbstract readReviewConsensus Statement
PubMed Full text at PMC Publisher
In one paragraph

Review in World journal of emergency surgery : WJES, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 3 registered trials, which are not on this map. Cited by 44 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
44citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

NCT07243808 not yet recruitingnot on this mapstarted 2026, after this paper: background citation

Comparison of Mixed Reality and Ultrasound Localization Techniques for Surgical Stabilization of Rib Fractures

TypeobservationalSponsorNational Taiwan University HospitalRan2026 to 2027Enrolled30ConditionsSurgical Stabilization of Rib Fracture
NCT07338617 not yet recruitingnot on this mapstarted 2026, after this paper: background citation

Point of Care Ultrasound (POCUS) for Diagnosis and Treatment of Fractures in the Costal Cartilage

TypeobservationalSponsorSahlgrenska University HospitalRan2026 to 2028Enrolled100ConditionsRib Fracture, Cartilage Damage
NCT07338656 nanot yet recruitingnot on this mapstarted 2026, after this paper: background citation

Surgery for Unstable Chest Wall Injuries - How Many Fractures Should be Fixed?

TypeinterventionalSponsorSahlgrenska University HospitalRan2026 to 2028Enrolled100ConditionsRib Fracture Multiple, Flail ChestArmsSurgical stabilization of two fractures per rib, Surgical stabilization of one fracture per rib.
3 · Its place in the literature

Who cites it

44 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. 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 · 2026
    Review
  3. Article
  4. ARDS management in trauma patients.Intensive care medicine · 2026
    Review
  5. Review
  6. Article
  7. Early treatment goal uncertainty as a barrier to regional analgesia and respiratory deterioration in traumatic rib fractures: a propensity-weighted analysis.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026
    Observational
  8. Article
  9. Article
  10. High-velocity gunshot chest trauma: tailoring patient care through insights from a mass casualty experience.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026
    Article
  11. Article
  12. Article
  13. Article
  14. Review
  15. Article
  16. Article
  17. Article
  18. Review
  19. Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

62 authors.

Giacomo SermonesiDepartment of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy.
Riccardo BertelliDepartment of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy.
Fredric M PieracciDepartment of Surgery, University of Colorado School of Medicine, Denver, CO, USA.
Zsolt J BaloghDepartment of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia.
Raul CoimbraComparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA.
Joseph M GalanteDivision of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA.
Andreas HeckerEmergency Medicine Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany.
Dieter WeberDepartment of Trauma Surgery, Royal Perth Hospital, Perth, Australia.
Zachary M BaumanDepartment of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
Susan KartikoDepartment of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Bhavik PatelDivision of Trauma, Gold Coast University Hospital, Southport, QLD, Australia.
SarahAnn S WhitbeckChest Wall Injury Society, Salt Lake City, UT, USA.
Thomas W WhiteIntermountain Medical Center, Salt Lake City, UT, USA.
Kevin N HarrellDepartment of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA.
Daniele PerrinaDepartment of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy.
Alessia RampiniDepartment of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy.
Brian TianDepartment of General Surgery, Singapore General Hospital, Singapore, Singapore.
Francesco AmicoDiscipline of Surgery, School of Medicine and Public Health, Newcastle, NSW, Australia.
Solomon G BekaEthiopian Air Force Hospital, Bishoftu, Oromia, Ethiopia. sologbeka@gmail.com.
Luigi BonavinaDepartment of Surgery, IRCCS Policlinico San Donato, University of Milano, Milan, Italy.
Marco CeresoliGeneral and Emergency Surgery Department, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy.
Lorenzo CobianchiDepartment of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Federico CoccoliniDepartment of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy.
Yunfeng CuiDepartment of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China.
Francesca Dal MasCollegium Medicum, University of Social Sciences, Lodz, Poland.
Belinda De SimoneDepartment of Minimally Invasive Emergency and General Surgery, Infermi Hospital, Rimini, Italy.
Isidoro Di CarloDepartment of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy.
Salomone Di SaverioGeneral Surgery Department Hospital of San Benedetto del Tronto, Marche Region, Italy.
Agron DogjaniDepartment of General Surgery, University of Medicine of Tirana, Tirana, Albania.
Andreas FettePediatric Surgery, Children's Care Center, SRH Klinikum Suhl, Suhl, Thueringen, Germany.
Gustavo P FragaDivision of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil.
Carlos Augusto GomesFaculdade de Medicina, SUPREMA, Hospital Universitario Terezinha de Jesus de Juiz de Fora, Juiz de Fora, MG, Brazil.
Jim S KhanDepartment of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
Andrew W KirkpatrickDepartments of Surgery and Critical Care Medicine, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
Vitor F KrugerDivision of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil.
Ari LeppäniemiAbdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Andrey LitvinDepartment of Surgical Diseases No. 3, University Clinic, Gomel State Medical University, Gomel, Belarus.
Andrea MingoliPoliclinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy.
David Costa NavarroColorectal Surgery Unit, Trauma Care Committee, Alicante General University Hospital, Alicante, Spain.
Eliseo PasseraDepartments of Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy.
Michele PisanoDepartments of Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy.
Mauro PoddaDepartment of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy.
Emanuele RussoDepartment of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy.
Boris SakakushevGeneral Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria.
Domenico SantonastasoDepartment of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy.
Massimo SartelliDepartment of Surgery, Macerata Hospital, Macerata, Italy.
Vishal G ShelatDepartment of General Surgery, Tan Tock Seng Hospital, Novena, Singapore.
Edward TanDepartment of Surgery, Radboud University Medical Center, Nijmegen, Netherlands.
Imtiaz WaniGovernment Gousia Hospital, Srinagar, India.
Fikri M Abu-ZidanDepartment of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al‑Ain, United Arab Emirates.
Walter L BifflDivision of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA.
Ian CivilFaculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Rifat LatifiDepartment of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Ingo MarziDepartment of Trauma Surgery and Orthopedics, University Hospital Goethe University Frankfurt, Frankfurt, Germany.
Edoardo PicettiDepartment of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.
Manos Pikoulis3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece.
Vanni AgnolettiDepartment of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy.
Francesca BraviHealthcare Administration, Santa Maria Delle Croci Hospital, Ravenna, Italy.
Carlo VallicelliDepartment of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy.
Luca AnsaloniDepartment of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Ernest E MooreDepartment of Surgery, University of Colorado School of Medicine, Denver, CO, USA.
Fausto CatenaDepartment of General and Emergency Surgery, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRib fractures are one of the most common traumatic injuries and may result in significant morbidity and mortality. Despite growing evidence, technological advances and increasing acceptance, surgical stabilization of rib fractures (SSRF) remains not uniformly considered in trauma centers. Indications, contraindications, appropriate timing, surgical approaches and utilized implants are part of an ongoing debate. The present position paper, which is endorsed by the World Society of Emergency Surgery (WSES), and supported by the Chest Wall Injury Society, aims to provide a review of the literature investigating the use of SSRF in rib fracture management to develop graded position statements, providing an updated guide and reference for SSRF.

methodsThis position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of experts then critically revised the manuscript and discussed it in detail, to develop a consensus on the position statements.

resultsA total of 287 studies (systematic reviews, randomized clinical trial, prospective and retrospective comparative studies, case series, original articles) have been selected from an initial pool of 9928 studies. Thirty-nine graded position statements were put forward to address eight crucial aspects of SSRF: surgical indications, contraindications, optimal timing of surgery, preoperative imaging evaluation, rib fracture sites for surgical fixation, management of concurrent thoracic injuries, surgical approach, stabilization methods and material selection.

conclusionThis consensus document addresses the key focus questions on surgical treatment of rib fractures. The expert recommendations clarify current evidences on SSRF indications, timing, operative planning, approaches and techniques, with the aim to guide clinicians in optimizing the management of rib fractures, to improve patient outcomes and direct future research.

Indexed as

Rib FracturesFracture FixationHumansConsensusFlail chestGuidelinesMinimally invasive plating osteosynthesis (MIPO)Multiple rib fracturesOperative reduction and internal fixation (ORIF)Rib fixationRib fracturesSurgical stabilization of rib fractures (SSRF)Thoracic/chest trauma injuryVideo-assisted thoracoscopy surgery (VATS)

Identifiers

PMID39425134
PMCPMC11487890

What OpenQuestion holds

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LicenceCC BY-NC-ND
Read underepoch 390

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.