title: Management of rib fractures in traumatic flail chest: a meta-analysis of randomised controlled trials.
abstract: OBJECTIVE
  Flail chest from a blunt injury to the thorax is associated with significant morbidity and mortality. Its management globally is predominantly non-operative; however, there are an increasing number of centres which undertake surgical stabilisation. The aim of this meta-analysis was to compare the efficacy of this approach with that of non-operative management.
  
  
  METHODS
  A systematic search of the literature was carried out to identify randomised controlled trials (RCTs) which compared the clinical outcome of patients with a traumatic flail chest treated by surgical stabilisation of any kind with that of non-operative management.
  
  
  RESULTS
  Of 1273 papers identified, three RCTs reported the results of 123 patients with a flail chest. Surgical stabilisation was associated with a two thirds reduction in the incidence of pneumonia when compared with non-operative management (risk ratio 0.36, 95% confidence interval (CI) 0.15 to 0.85, p = 0.02). The duration of mechanical ventilation (mean difference -6.30 days, 95% CI -12.16 to -0.43, p = 0.04) and length of stay in an intensive care unit (mean difference -6.46 days, 95% CI 9.73 to -3.19, p = 0.0001) were significantly shorter in the operative group, as was the overall length of stay in hospital (mean difference -11.39, 95% CI -12.39 to -10.38, p < 0.0001).
  
  
  CONCLUSIONS
  Surgical stabilisation for a traumatic flail chest is associated with significant clinical benefits in this meta-analysis of three relatively small RCTs. Cite this article: Bone Joint J 2016;98-B:1119-25.
authors.affiliation: Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
authors.forename: T A
authors.initials: TA
authors.lastname: Coughlin
authors.affiliation: Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
authors.forename: J W G
authors.initials: JW
authors.lastname: Ng
authors.affiliation: Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
authors.forename: K E
authors.initials: KE
authors.lastname: Rollins
authors.affiliation: Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
authors.forename: D P
authors.initials: DP
authors.lastname: Forward
authors.affiliation: University of Nottingham, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
authors.forename: B J
authors.initials: BJ
authors.lastname: Ollivere
mesh_terms: D000328:Adult; D005260:Female; D005409:Flail Chest / Q000401:mortality / Q000628:therapy*; D005592:Fracture Fixation / Q000379:methods / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D011014:Pneumonia / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000401:mortality; D012253:Rib Fractures / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000628:therapy*
keywords: Chest injury; Internal fixation; Meta-analysis; Rib fracture