ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2026
Minimally invasive versus open fixation for flail chest in elderly patients: a prospective cohort study on perioperative safety and long-term outcomes.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo systematically evaluate the perioperative safety and short- and long-term efficacy of minimally Invasive fixation using a reversed shape-memory alloy plate versus conventional open fixation for the treatment of flail chest in elderly patients.
methodsThis prospective cohort study enrolled 130 elderly patients (≥ 60 years) with flail chest between January 2022 and January 2026. After 1:1 propensity score matching, 100 patients were included (minimally invasive group, n = 50; open group, n = 50). Perioperative parameters (operative time, blood loss, C-reactive protein(CRP) at 24 h/48 h/72 h, complications), short-term outcomes (resting/cough-evoked Numerical Rating Scale(NRS) pain scores, non-steroidal analgesic drug duration, rescue analgesic frequency, Patient-Controlled Analgesia Pump(PCA) consumption, time to ambulation, hospital stay), and long-term outcomes (implant dislodgement, 6-month pulmonary function, Douleur Neuropathique 4 Questions Naire(DN4), Medical Outcomes Study 36- Item Short Form Health Survey(SF-36)) were compared.
resultsThe minimally invasive group had significantly fewer incision-related complications (P = 0.046), lower resting NRS scores on postoperative days 1 and 3 (P < 0.01; P = 0.041), lower cough-evoked NRS score on day 1 (P = 0.011), shorter non-steroidal analgesic duration (P < 0.01), and lower PCA consumption (P = 0.027). At 6 months, the minimally invasive group showed significantly lower DN4 scores (P = 0.03). No significant differences were observed in other outcomes.
conclusionminimally invasive fixation with a reversed shape-memory alloy plate is a safe, effective minimally invasive technique for elderly flail chest patients, offering advantages in incision-related complications, early pain control, analgesic requirements, and reduced risk of chronic neuropathic pain.
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