Surgical and traditional methods for the treatment of multiple rib fractures: A systematic review and meta-analysis of randomized controlled trials_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHANG Hao ^1,2 , FENG Ting ³ , PEI Zhijie ² , GUO Zhitao ¹ , GUAN Wanpeng ¹

1. Trauma Treatment Center, Tianjin Xiqing Hospital, Tianjin, 300380, P.R.China;
2. Department of Thoracic Surgery, Tianjin Xiqing Hospital, Tianjin, 300380, P.R.China;
3. Medical Imaging Center, Tianjin Xiqing Hospital, Tianjin, 300380, P.R.China;

Corresponding?author：

ZHANG Hao, Email: ctjd_zh@126.com

Keywords：

Rib fractures; surgery; traditional treatment; systematic review; meta-analysis

DOI：

10.7507/1007-4848.201907076

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the effect of surgical and traditional treatments for multiple rib fractures through systematic review and meta-analysis.Methods CNKI, Wanfang, VIP, PubMed, OVID, EMbase, The Cochrane Library, Thieme and Springer Link database for information from inception to July 2019 were screened by computer. Randomized controlled trials (RCTs) of surgical and conventional methods for the treatment of multiple rib fractures were screened, assessed and extracted. RevMan 5.3 software was used for meta-analysis.Results Twelve studies were included, including 1 039 patients. There were 512 patients in the operation group and 527 patients in the traditional treatment group. The results of meta-analysis showed that there was a significant difference between the two groups in the incidence of pneumonia (RR=0.41, 99%CI 0.29 to 0.58, P<0.000 01), incidence of atelectasis (RR=0.24, 99%CI 0.06 to 0.94, P=0.007), duration of mechanical ventilation (SMD=–2.64, 99%CI –4.38 to –0.91, P<0.000 1), duration of intensive care unit stay (SMD=–1.33, 99%CI –2.26 to –0.40, P=0.000 2), duration of hospital stay (SMD=–2.25, 99%CI –3.30 to –1.19, P<0.000 01)and incidence of chest wall deformity (RR=0.08, 99%CI 0.04 to 0.17, P<0.000 01). There was no significant difference between the two groups in the hospital mortality (RR=0.75, 99%CI 0.23 to 2.46, P=0.53), incidence of tracheostomy (RR= 0.69, 99%CI 0.39 to 1.21, P=0.09), ventilator support rate (RR=0.65, 99%CI 0.41 to 1.05, P=0.02) and chest drainage time (SMD=–2.58, 99%CI –6.41 to 1.25, P=0.08).Conclusion Surgical treatment of multiple rib fractures can reduce pulmonary complications, shorten hospital stay, and reduce the incidence of chest wall deformity, which is conducive to rapid recovery and improves quality of life.

Citation： ZHANG Hao, FENG Ting, PEI Zhijie, GUO Zhitao, GUAN Wanpeng. Surgical and traditional methods for the treatment of multiple rib fractures: A systematic review and meta-analysis of randomized controlled trials. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(5): 558-568. doi: 10.7507/1007-4848.201907076 Copy

1.	Ten Duis K, IJpma FF. Surgical treatment of snapping scapula syndrome due to malunion of rib fractures. Ann Thorac Surg, 2017, 103(2): e143-e144.
2.	Marasco S, Lee G, Summerhayes R, et al. Quality of life after major trauma with multiple rib fractures. Injury, 2015, 46(1): 61-65.
3.	Lafferty PM, Anavian J, Will RE, et al. Operative treatment of chest wall injuries: indications, technique, and outcomes. J Bone Joint Surg Am, 2011, 93(1): 97-110.
4.	Veysi VT, Nikolaou VS, Paliobeis C, et al. Prevalence of chest trauma, associated injuries and mortality: a level Ⅰ trauma centre experience. Int Orthop, 2009, 33(5): 1425-1433.
5.	Jayle CP, Allain G, Ingrand P, et al. Flail chest in polytraumatized patients: surgical fixation using Stracos reduces ventilator time and hospital stay. Biomed Res Int, 2015, 624723.
6.	Vana PG, Neubauer DC, Luchette FA. Contemporary management of flail chest. Am Surg, 2014, 80(6): 527-535.
7.	Velasquez M, Ordo?ez CA, Parra MW, et al. Operative versus nonoperative management of multiple rib fractures. Am Surg, 2016, 82(5): e103-e105.
8.	Bhatnagar A, Mayberry J, Nirula R. Rib fracture fixation for flail chest: what is the benefit? J Am Coll Surg, 2012, 215(2): 201-205.
9.	Schulte K, Whitaker D, Attia R. In patients with acute flail chest does surgical rib fixation improve outcomes in terms of morbidity and mortality? Interact Cardiovasc Thorac Surg, 2016, 23(2): 314-319.
10.	Girsowicz E, Falcoz PE, Santelmo N, et al. Does surgical stabilization improve outcomes in patients with isolated multiple distracted and painful non-flail rib fractures? Interact Cardiovasc Thorac Surg, 2012, 14(3): 312-315.
11.	Pieracci FM, Lin Y, Rodil M, et al. A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures. J Trauma Acute Care Surg, 2016, 80(2): 187-194.
12.	Majercik S, Vijayakumar S, Olsen G, et al. Surgical stabilization of severe rib fractures decreases incidence of retained hemothorax and empyema. Am J Surg, 2015, 210(6): 1112-1117.
13.	Majak P, N?ss PA. Rib fractures in trauma patients: does operative fixation improve outcome? Curr Opin Crit Care, 2016, 22(6): 572-577.
14.	DeFreest L, Tafen M, Bhakta A, et al. Open reduction and internal fixation of rib fractures in polytrauma patients with flail chest. Am J Surg, 2016, 211(4): 761-767.
15.	Swart E, Laratta J, Slobogean G, et al. Operative treatment of rib fractures in flail chest injuries: a meta-analysis and cost-effectiveness analysis. J Orthop Trauma, 2017, 31(2): 64-70.
16.	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(2): 163-168.
17.	Liang YS, Yu KC, Wong CS, et al. Does surgery reduce the risk of complications among patients with multiple rib fractures? A meta-analysis. Clin Orthop Relat Res, 2019, 477(1): 193-205.
18.	Ingoe HM, Coleman E, Eardley W, et al. Systematic review of systematic reviews for effectiveness of internal fixation for flail chest and rib fractures in adults. BMJ Open, 2019, 9(4): e023444.
19.	宋銳強, 鄧彥超, 王志鵬, 等. 保守治療與切開復位內固定術治療多發肋骨骨折療效的系統評價. 中國循證醫學雜志, 2018, 18(12): 1329-1336.
20.	曹伯雄, 李琴, 盧明水, 等. 切開復位內固定術與非手術治療多發肋骨骨折療效的 Meta 分析. 中華創傷雜志, 2017, 33(3): 275-280.
21.	J?rgensen L, Paludan-Müller AS, Laursen DR, et al. Evaluation of the Cochrane tool for assessing risk of bias in randomized clinical trials: overview of published comments and analysis of user practice in Cochrane and non-Cochrane reviews. Syst Rev, 2016, 5: 80.
22.	Granetzny A, Abd El-Aal M, Emam E, et al. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact Cardiovasc Thorac Surg, 2005, 4(6): 583-587.
23.	Liu T, Liu P, Chen J, et al. A randomized controlled trial of surgical rib fixation in polytrauma patients with flail chest. J Surg Res, 2019, 242: 223-230.
24.	Marasco SF, Davies AR, Cooper J, et al. Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg, 2013, 216(5): 924-32.
25.	Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma, 2002, 52(4): 727-732.
26.	Wu WM, Yang Y, Gao ZL, et al. Which is better to multiple rib fractures, surgical treatment or conservative treatment? Int J Clin Exp Med, 2015, 8(5): 7930-7936.
27.	岑小波, 劉浩, 陳光明, 等. TiNi 環抱式接骨器內固定治療多發性肋骨骨折. 中國胸心血管外科臨床雜志, 2013, 20(4): 476-478.
28.	張子騰, 艾仕文, 胡志亮, 等. 肋骨骨折切開復位內固定術與保守治療在重癥胸外傷治療中的臨床效果比較. 醫學綜述, 2016, 22(6): 1198-1200.
29.	李彥玉, 劉斌, 王四海. 多發性肋骨骨折內固定術與保守治療的成本-效果分析. 醫學綜述, 2014, 20(17): 3224-3226.
30.	熊健, 王長濤, 吳蕾, 等. 疼痛和動脈血二氧化碳分壓作為肋骨骨折患者手術指征的臨床分析. 中國胸心血管外科臨床雜志, 2011, 18(5): 474-475.
31.	王立, 古麗尼格爾·吐爾遜, 康迪, 等. 內固定手術治療多發性肋骨骨折的療效與安全性的隨機對照試驗. 中國胸心血管外科臨床雜志, 2014, 21(2): 228-232.
32.	胡為才, 邵換璋, 張全, 等. 胸腔鏡輔助下形狀記憶肋骨環抱接骨板內固定治療多發性肋骨骨折的臨床研究. 創傷外科雜志, 2018, 20(2): 88-91.
33.	陳勇杰, 張德鋒, 易宏, 等. 損傷控制性肋骨接骨板手術在創傷性連枷胸中的應用價值. 中華全科醫學, 2016, 14(10): 1657-1659.
34.	Topcu I, Ekici Z, Sakarya M. Comparison of clinical effectiveness of thoracic epidural and intravenous patient-controlled analgesia for the treatment of rib fractures pain in intensive care unit. Ulus Travma Acil Cerrahi Derg, 2007, 13(3): 205-210.
35.	Dehghan N, De Mestral C, Mckee MD, et al. Flail chest injuries: a review of outcomes and treatment practices from the National Trauma Data Bank. J Trauma Acute Care Surg, 2014, 76(2): 462-468.
36.	Karmakar MK, Ho AM. Acute pain management of patients with multiple fractured ribs. J Trauma, 2003, 54(3): 615-625.
37.	Brasel KJ, Guse CE, Layde P, et al. Rib fractures: relationship with pneumonia and mortality. Crit Care Med, 2006, 34(6): 1642-1646.
38.	Fagevik Olsén M, Slobo M, Klarin L, et al. Physical function and pain after surgical or conservative management of multiple rib fractures-a follow-up study. Scand J Trauma Resusc Emerg Med, 2016, 24(1): 128.
39.	喬貴賓, 陳剛. 創傷性肋骨骨折的處理: 廣東胸外科行業共識 (2017 年版). 中國胸心血管外科臨床雜志, 2018, 25(5): 362-367.
40.	Brasel KJ, Moore EE, Albrecht RA, et al. Western Trauma Association Critical Decisions in Trauma: Management of rib fractures. J Trauma Acute Care Surg, 2017, 82(1): 200-203.
41.	Kasotakis G, Hasenboehler EA, Streib EW, et al. Operative fixation of rib fractures after blunt trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg, 2017, 82(3): 618-626.
42.	Dumans-Nizard V, Guezennec J, Parquin F, et al. Feasibility and results of a fast-track protocol in thoracic surgery. Minerva Anestesiol, 2016, 82(1): 15-21.
43.	Loop T. Fast track in thoracic surgery and anaesthesia: update of concepts. Curr Opin Anaesthesiol, 2016, 29(1): 20-25.

1. Ten Duis K, IJpma FF. Surgical treatment of snapping scapula syndrome due to malunion of rib fractures. Ann Thorac Surg, 2017, 103(2): e143-e144.
2. Marasco S, Lee G, Summerhayes R, et al. Quality of life after major trauma with multiple rib fractures. Injury, 2015, 46(1): 61-65.
3. Lafferty PM, Anavian J, Will RE, et al. Operative treatment of chest wall injuries: indications, technique, and outcomes. J Bone Joint Surg Am, 2011, 93(1): 97-110.
4. Veysi VT, Nikolaou VS, Paliobeis C, et al. Prevalence of chest trauma, associated injuries and mortality: a level Ⅰ trauma centre experience. Int Orthop, 2009, 33(5): 1425-1433.
5. Jayle CP, Allain G, Ingrand P, et al. Flail chest in polytraumatized patients: surgical fixation using Stracos reduces ventilator time and hospital stay. Biomed Res Int, 2015, 624723.
6. Vana PG, Neubauer DC, Luchette FA. Contemporary management of flail chest. Am Surg, 2014, 80(6): 527-535.
7. Velasquez M, Ordo?ez CA, Parra MW, et al. Operative versus nonoperative management of multiple rib fractures. Am Surg, 2016, 82(5): e103-e105.
8. Bhatnagar A, Mayberry J, Nirula R. Rib fracture fixation for flail chest: what is the benefit? J Am Coll Surg, 2012, 215(2): 201-205.
9. Schulte K, Whitaker D, Attia R. In patients with acute flail chest does surgical rib fixation improve outcomes in terms of morbidity and mortality? Interact Cardiovasc Thorac Surg, 2016, 23(2): 314-319.
10. Girsowicz E, Falcoz PE, Santelmo N, et al. Does surgical stabilization improve outcomes in patients with isolated multiple distracted and painful non-flail rib fractures? Interact Cardiovasc Thorac Surg, 2012, 14(3): 312-315.
11. Pieracci FM, Lin Y, Rodil M, et al. A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures. J Trauma Acute Care Surg, 2016, 80(2): 187-194.
12. Majercik S, Vijayakumar S, Olsen G, et al. Surgical stabilization of severe rib fractures decreases incidence of retained hemothorax and empyema. Am J Surg, 2015, 210(6): 1112-1117.
13. Majak P, N?ss PA. Rib fractures in trauma patients: does operative fixation improve outcome? Curr Opin Crit Care, 2016, 22(6): 572-577.
14. DeFreest L, Tafen M, Bhakta A, et al. Open reduction and internal fixation of rib fractures in polytrauma patients with flail chest. Am J Surg, 2016, 211(4): 761-767.
15. Swart E, Laratta J, Slobogean G, et al. Operative treatment of rib fractures in flail chest injuries: a meta-analysis and cost-effectiveness analysis. J Orthop Trauma, 2017, 31(2): 64-70.
16. 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(2): 163-168.
17. Liang YS, Yu KC, Wong CS, et al. Does surgery reduce the risk of complications among patients with multiple rib fractures? A meta-analysis. Clin Orthop Relat Res, 2019, 477(1): 193-205.
18. Ingoe HM, Coleman E, Eardley W, et al. Systematic review of systematic reviews for effectiveness of internal fixation for flail chest and rib fractures in adults. BMJ Open, 2019, 9(4): e023444.
19. 宋銳強, 鄧彥超, 王志鵬, 等. 保守治療與切開復位內固定術治療多發肋骨骨折療效的系統評價. 中國循證醫學雜志, 2018, 18(12): 1329-1336.
20. 曹伯雄, 李琴, 盧明水, 等. 切開復位內固定術與非手術治療多發肋骨骨折療效的 Meta 分析. 中華創傷雜志, 2017, 33(3): 275-280.
21. J?rgensen L, Paludan-Müller AS, Laursen DR, et al. Evaluation of the Cochrane tool for assessing risk of bias in randomized clinical trials: overview of published comments and analysis of user practice in Cochrane and non-Cochrane reviews. Syst Rev, 2016, 5: 80.
22. Granetzny A, Abd El-Aal M, Emam E, et al. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact Cardiovasc Thorac Surg, 2005, 4(6): 583-587.
23. Liu T, Liu P, Chen J, et al. A randomized controlled trial of surgical rib fixation in polytrauma patients with flail chest. J Surg Res, 2019, 242: 223-230.
24. Marasco SF, Davies AR, Cooper J, et al. Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg, 2013, 216(5): 924-32.
25. Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma, 2002, 52(4): 727-732.
26. Wu WM, Yang Y, Gao ZL, et al. Which is better to multiple rib fractures, surgical treatment or conservative treatment? Int J Clin Exp Med, 2015, 8(5): 7930-7936.
27. 岑小波, 劉浩, 陳光明, 等. TiNi 環抱式接骨器內固定治療多發性肋骨骨折. 中國胸心血管外科臨床雜志, 2013, 20(4): 476-478.
28. 張子騰, 艾仕文, 胡志亮, 等. 肋骨骨折切開復位內固定術與保守治療在重癥胸外傷治療中的臨床效果比較. 醫學綜述, 2016, 22(6): 1198-1200.
29. 李彥玉, 劉斌, 王四海. 多發性肋骨骨折內固定術與保守治療的成本-效果分析. 醫學綜述, 2014, 20(17): 3224-3226.
30. 熊健, 王長濤, 吳蕾, 等. 疼痛和動脈血二氧化碳分壓作為肋骨骨折患者手術指征的臨床分析. 中國胸心血管外科臨床雜志, 2011, 18(5): 474-475.
31. 王立, 古麗尼格爾·吐爾遜, 康迪, 等. 內固定手術治療多發性肋骨骨折的療效與安全性的隨機對照試驗. 中國胸心血管外科臨床雜志, 2014, 21(2): 228-232.
32. 胡為才, 邵換璋, 張全, 等. 胸腔鏡輔助下形狀記憶肋骨環抱接骨板內固定治療多發性肋骨骨折的臨床研究. 創傷外科雜志, 2018, 20(2): 88-91.
33. 陳勇杰, 張德鋒, 易宏, 等. 損傷控制性肋骨接骨板手術在創傷性連枷胸中的應用價值. 中華全科醫學, 2016, 14(10): 1657-1659.
34. Topcu I, Ekici Z, Sakarya M. Comparison of clinical effectiveness of thoracic epidural and intravenous patient-controlled analgesia for the treatment of rib fractures pain in intensive care unit. Ulus Travma Acil Cerrahi Derg, 2007, 13(3): 205-210.
35. Dehghan N, De Mestral C, Mckee MD, et al. Flail chest injuries: a review of outcomes and treatment practices from the National Trauma Data Bank. J Trauma Acute Care Surg, 2014, 76(2): 462-468.
36. Karmakar MK, Ho AM. Acute pain management of patients with multiple fractured ribs. J Trauma, 2003, 54(3): 615-625.
37. Brasel KJ, Guse CE, Layde P, et al. Rib fractures: relationship with pneumonia and mortality. Crit Care Med, 2006, 34(6): 1642-1646.
38. Fagevik Olsén M, Slobo M, Klarin L, et al. Physical function and pain after surgical or conservative management of multiple rib fractures-a follow-up study. Scand J Trauma Resusc Emerg Med, 2016, 24(1): 128.
39. 喬貴賓, 陳剛. 創傷性肋骨骨折的處理: 廣東胸外科行業共識 (2017 年版). 中國胸心血管外科臨床雜志, 2018, 25(5): 362-367.
40. Brasel KJ, Moore EE, Albrecht RA, et al. Western Trauma Association Critical Decisions in Trauma: Management of rib fractures. J Trauma Acute Care Surg, 2017, 82(1): 200-203.
41. Kasotakis G, Hasenboehler EA, Streib EW, et al. Operative fixation of rib fractures after blunt trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg, 2017, 82(3): 618-626.
42. Dumans-Nizard V, Guezennec J, Parquin F, et al. Feasibility and results of a fast-track protocol in thoracic surgery. Minerva Anestesiol, 2016, 82(1): 15-21.
43. Loop T. Fast track in thoracic surgery and anaesthesia: update of concepts. Curr Opin Anaesthesiol, 2016, 29(1): 20-25.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical and traditional methods for the treatment of multiple rib fractures: A systematic review and meta-analysis of randomized controlled trials

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content