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Comparative Study
. 2025 Jan 24;51(1):45.
doi: 10.1007/s00068-024-02760-z.

Effects of osteosynthesis of the bony thorax in the context of polytrauma compared to conservative treatment: a systematic review

Karolina Dahms  1 , Jan Volmerig  2 , Julia Dormann  1 , Eva Steinfeld  1 , Kelly Ansems  1 , Heidrun Janka  3 , Maria-Inti Metzendorf  3 , Carina Benstoem  4
Affiliations
Comparative Study

Effects of osteosynthesis of the bony thorax in the context of polytrauma compared to conservative treatment: a systematic review

Karolina Dahms et al. Eur J Trauma Emerg Surg. .

Abstract

Purpose: Osteosynthesis seems to have effects regarding clinical outcomes in trauma patients. However, current knowledge on chest wall osteosynthesis in polytrauma patients is insufficient, leaving its potential unanswered. Therefore, the objective of this systematic review is to assess the safety and effects of chest wall osteosynthesis compared to conservative treatment on clinical outcomes in adult polytrauma patients.

Methods: We searched PubMed to identify completed and ongoing studies from inception of each database to May, 2022. We included systematic reviews including RCTs comparing chest wall osteosynthesis to conservative treatment in adult polytrauma patients.

Results: We included one RCT with 50 patients (nosteosyntheses = 25, ncontrol = 25, median age 37.4 years, 82% male). We found that surgical rib fixation makes little or no difference to in-hospital mortality compared to conservative treatment (RR 2.00, 95% CI 0.40 to 9.95; RD 80 more per 1,000, 95% CI 48 fewer to 716 more; 1 study, 50 participants, low quality of evidence). We found that surgical rib fixation makes little or no difference to the need for mechanical ventilation compared to conservative treatment (RR 0.90, 95% CI -0.66 to 1.23; RD 80 fewer per 1,000, 95% CI 272 fewer to 184 more; 1 study, 50 participants, low certainty of evidence).

Conclusion: There is limited evidence regarding chest wall osteosynthesis compared to conservative treatment in polytrauma patients. One RCT shows no effect of surgical rib fixation compared to conservative treatment regarding mortality and clinical status, but a potential benefit regarding ICU length of stay.

Keywords: ICU; Intensive care unit; Multiple trauma; Polytrauma; Rib fixation; SSRF.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Conflict of interest: The authors have disclosed that they do not have any competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the systematic review selection process
Fig. 2
Fig. 2
Forest plot describing the difference between surgical rib fixation compared to conservative treatment regarding all-cause mortality
Fig. 3
Fig. 3
Forest plot describing the difference between surgical rib fixation compared to conservative treatment regarding Need for mechanical ventilation
See this image and copyright information in PMC

References

    1. Schuurmans J, Goslings JC, Schepers T. Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review. Eur J Trauma Emerg Surg. 2017;43:163–8. - PMC - PubMed
    1. Kocher GJ, Sharafi S, Azenha LF, Schmid RA. Chest wall stabilization in ventilator-dependent traumatic flail chest patients: who benefits? Eur J Cardiothorac Surg. 2017;51(4):696–701. - PubMed
    1. Swart E, Laratta J, Slobogean G, Mehta S. Operative treatment of Rib fractures in Flail chest injuries: a Meta-analysis and cost-effectiveness analysis. J Orthop Trauma. 2017;31(2):64–70. - PubMed
    1. DeFreest L, Tafen M, Bhakta A, Ata A, Martone S, Glotzer O, Krautsak K, Rosati C, Stain SC, Bonville D. Open reduction and internal fixation of rib fractures in polytrauma patients with flail chest. Am J Surg. 2016;21(4):761–7. - PubMed
    1. Cataneo AJ, Cataneo DC, de Oliveira FH, Arruda KA, El Dib R, de Oliveira Carvalho PE. Surgical versus nonsurgical interventions for flail chest. Cochrane Database Syst Rev. 2015;(7):CD009919. - PMC - PubMed

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