Evaluation of efficacy and indications of surgical fixation for multiple rib fractures: a propensity-score matched analysis

  • K. UchidaEmail author
  • T. Nishimura
  • H. Takesada
  • T. Morioka
  • N. Hagawa
  • T. Yamamoto
  • S. Kaga
  • T. Terada
  • N. Shinyama
  • H. Yamamoto
  • Y. Mizobata
Original Article



The purpose of this study was to assess the effects of recent surgical rib fixation and establish its indications not only for flail chest but also for multiple rib fractures.


Between 2007 and 2015, 187 patients were diagnosed as having multiple rib fractures in our institution. After the propensity score matching was performed, ten patients who had performed surgical rib fixation and ten patients who had treated with non-operative management were included. Categorical variables were analyzed with Fischer’s exact test and non-parametric numerical data were compared using the Mann–Whitney U test. Wilcoxon signed-rank test was performed for comparison of pre- and postoperative variables. All statistical data are presented as median (25–75 % interquartile range [IQR]) or number.


The surgically treated patients extubated significantly earlier than non-operative management patients (5.5 [1–8] vs 9 [7–12] days: p = 0.019). The duration of continuous intravenous narcotic agents infusion days (4.5 [3–6] vs 12 [9–14] days: p = 0.002) and the duration of intensive care unit stay (6.5 [3–9] vs 12 [8–14] days: p = 0.008) were also significantly shorter in surgically treated patients. Under the same ventilating conditions, the postoperative values of tidal volume and respiratory rate improved significantly compared to those values measured just before the surgery. The incidence of pneumonia as a complication was significantly higher in non-operative management group (p = 0.05).


From the viewpoints of early respiratory stabilization and intensive care unit disposition without any complications, surgical rib fixation is a sufficiently acceptable procedure not only for flail chest but also for repair of severe multiple rib fractures.


Flail chest Multiple rib fractures Operative result Surgical rib fixation Non-operative management 



Computed tomography


Abbreviated Injury Scale


Glasgow Coma Scale


Non-operative management


Intensive care unit


Interquartile range


Compliance with ethical standards

Conflict of interest

The all authors declare that there are no conflicts of interest in relation to this manuscript.

Informed consent

Written informed consent was obtained from the patients for publication of this report and any accompanying images.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • K. Uchida
    • 1
    Email author
  • T. Nishimura
    • 1
  • H. Takesada
    • 1
  • T. Morioka
    • 1
  • N. Hagawa
    • 1
  • T. Yamamoto
    • 1
  • S. Kaga
    • 1
  • T. Terada
    • 1
  • N. Shinyama
    • 1
  • H. Yamamoto
    • 1
  • Y. Mizobata
    • 1
  1. 1.Department of Traumatology and Critical Care MedicineOsaka City University, Graduate School of MedicineOsaka CityJapan

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