Journal of Innovative Clinical Trials and Case Reports

Abstract

Background: Multiple rib fractures are a major determinant of morbidity following blunt chest trauma, often resulting in prolonged mechanical ventilation, pulmonary infections, and protracted hospitalization. Surgical stabilization of rib fractures (SSRF) has been shown to improve outcomes in high-resource clinical trials, but real-world outcome data from public tertiary trauma systems in developing nations remain limited.

Objective: To compare clinical, respiratory, and resource-utilization outcomes between patients undergoing SSRF and those managed with standard non-operative management (SNOM) for severe multiple rib fractures.

Methods: We performed a retrospective cohort study of 72 adult patients (SSRF: n = 24; SNOM: n = 48) treated between January 2024 and December 2025 at a single Level-1 equivalent trauma center. Inclusion criteria comprised flail chest or 3 ipsilateral, severely displaced fractures of ribs 3–10. Primary outcomes included hospital and ICU length of stay (LOS), post-treatment pain (Visual Analogue Scale [VAS]), and incidence of pneumonia. Multivariable linear and logistic regression analyses were conducted to adjust for baseline imbalances, specifically rib fracture count and Injury Severity Score (ISS).

Results: Baseline characteristics—including age (48.42 ± 15.76 vs. 46.04 ± 15.75 years), sex (58.3% vs. 47.9% male), mechanism of injury, and flail chest proportion (54.2% vs. 52.1%)—did not differ significantly between the SSRF and SNOM cohorts. However, SSRF patients presented with a significantly higher mean fracture count (6.00 ± 1.64 vs. 4.96 ± 1.75, p = 0.016). Following intervention, the SSRF cohort demonstrated significantly shorter ICU stays (2.58 ± 1.02 vs. 3.75 ± 1.36 days, p < 0.001) and shorter total hospital admissions (7.33 ± 1.52 vs. 10.69 ± 2.25 days, p < 0.001). The incidence of pneumonia was markedly lower in the SSRF group (20.8% [5/24] vs. 54.2% [26/48], p = 0.015). On multivariable regression adjusting for fracture count and ISS, SSRF remained an independent predictor of reduced hospital LOS ( = -3.28 days, 95% CI: -4.18 to -2.38, p < 0.001) and reduced odds of pneumonia (adjusted OR = 0.21, 95% CI: 0.06 to 0.71, p = 0.012). Ventilator duration did not differ significantly between cohorts (0.79 ± 1.25 vs. 1.29 ± 1.66 days, p = 0.159).

Conclusion: In appropriately selected patients with multiple rib fractures, SSRF was independently associated with expedited discharge, shorter ICU stays, improved spirometric parameters, and significantly reduced pulmonary infections compared to SNOM. These benefits were maintained despite higher anatomical injury burden in the surgical arm.