The evaluation of pulmonary function after rib fixation for multiple rib fractures and flail chest: a retrospective study and systematic review of the current evidence

  • Jesse PeekEmail author
  • Reinier Bart Beks
  • Valerie Kremo
  • Nicole van Veelen
  • Alfred Leiser
  • Roderick Marijn Houwert
  • Björn-Christian Link
  • Matthias Knobe
  • Reto Hansjörg Babst
  • Frank Joseph Paulus Beeres
Original Article



The primary aim of this retrospective cohort study was to evaluate the pulmonary function after rib fixation for patients with multiple rib fractures and flail chest. Secondary, a systematic review was performed to give an overview of the current literature and to allow comparison with our results.


All adult (≥ 18 years) patients who underwent rib fixation for multiple rib fractures or flail chest between 2010 and 2018 and who received a control pulmonary function test during the postoperative follow-up at our level-1 trauma center were retrospectively reviewed. Secondary, the PubMed, EMBASE and Cochrane databases were searched to identify studies reporting on the pulmonary function after rib fixation. The primary outcome parameters were the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, maximum vital capacity (VCmax), total lung capacity (TLC), residual volume (RV), and RV/TC ratio.


Of the 103 patients who underwent rib fixation, a total of 61 (59%) patients underwent a pulmonary function test in our hospital and were ultimately included. In the majority of patients all pulmonary function parameters fell within the normal range of the reference values. Obstructive impairment was predominantly seen in patients with pre-existing chronic obstructive pulmonary disease (COPD). Patients with multiple rib fractures had better recovery compared to those with a flail chest. The systematic review included a total of 15 studies and showed comparable results.


The present study demonstrates that rib fixation for multiple rib fractures or flail chest results in adequate recovery of the pulmonary function within 3 months after surgery. In addition, based on the current literature, further gradual improvement to maximum pulmonary values appears to occur during the first 12 months after rib fixation.


Rib fixation Flail chest Multiple rib fractures Pulmonary function 



A special thanks goes to Dr. med. Reinhard Schläpfer and the Department of Pulmonology for their assistance with the data extraction.


The authors received no financial support for the research, authorship, and/or publication of this article.

Compliance with ethical standards

Conflict of interest

The authors declared no conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplementary material

68_2019_1274_MOESM1_ESM.docx (15 kb)
Supplementary file1 (DOCX 15 kb)
68_2019_1274_MOESM2_ESM.docx (13 kb)
Supplementary file2 (DOCX 12 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jesse Peek
    • 1
    • 2
    Email author
  • Reinier Bart Beks
    • 1
    • 2
  • Valerie Kremo
    • 1
  • Nicole van Veelen
    • 1
  • Alfred Leiser
    • 3
  • Roderick Marijn Houwert
    • 2
  • Björn-Christian Link
    • 1
  • Matthias Knobe
    • 1
  • Reto Hansjörg Babst
    • 1
  • Frank Joseph Paulus Beeres
    • 1
  1. 1.Department of Orthopedic and Trauma SurgeryCantonal Hospital LucerneLucerneSwitzerland
  2. 2.Department of SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
  3. 3.Department of Thoracic and Cardiovascular SurgeryCantonal Hospital LucerneLucerneSwitzerland

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