National Changes in Timing and Rates of Surgical Stabilization of Rib Fractures (SSRF): SSRF Occurring Early and More Often

Abstract

Surgical stabilization of rib fractures (SSRF) has garnered increased attention recently for treatment of blunt chest trauma (BCT). This study evaluated temporal trends in rates and timing of SSRF in isolated BCT patients, hypothesizing increased rates of early SSRF and SSRF overall. The 2017-2023 Trauma Quality Improvement Program (TQIP) database was queried for patients with ≥2 rib fractures and abbreviated injury scale <2 in non-chest regions to delineate an isolated BCT cohort. Patients were stratified by timing of SSRF from arrival: early (≤72 h), intermediate (>72-≤ 120 h), and late (>120 h). The primary outcome was annual rate of SSRF. Of 371,193 isolated BCT patients, 17 966 (4.8%) underwent SSRF from 2017 to 2023. The median age of patients undergoing SSRF increased from 58 years in 2017 to 61 years in 2023 (P < 0.001). There was an increased rate of SSRF performed from 2017 to 2023 (n = 1,594, 3.5% vs n = 3,435, 5.5%, P < 0.001). When stratified by timing, early (1.8% [2017]; 3.4% [2023], P < 0.001) and intermediate SSRF (0.9% [2017]; 1.3% [2023], P < 0.001) increased over time, whereas late SSRF remained similar across 2017 to 2023 (late: 0.8%; 0.8%, P = 0.25). For all SSRF patients, median overall length of stay (LOS) decreased over time (12 [IQR: 8-17] days [2017]; 11 [IQR: 8-16] days [2023]; P < 0.001). This study demonstrates a nearly 60% relative national increase in SSRF from 2017 to 2023, with a progressively older patient cohort and shorter LOS. This was predominantly attributable to increased early (≤72 h) and intermediate (>72-≤120 h) SSRF cases, aligning with existing guidelines.

Keywords

trauma outcomes surgical stabilization of rib fractures national trends rib fractures TQIP

Introduction

Rib fractures are a common consequence of blunt thoracic trauma, with some studies reporting fractures in 10% of all trauma patients¹ and up to 55% of patients who experienced specifically blunt chest trauma.^2,3 Mortality associated with rib fractures ranges from 6% to 12% and increases with a greater number of fractures.^2,3 Among patients older than 65 years, rib fractures are associated with a 2-fold higher risk of mortality compared to younger adults.^4,5

Historically, the management of rib fractures has been predominantly nonoperative, emphasizing analgesia, pulmonary hygiene, and supportive care.⁶ Though there have been several surgical approaches to rib fixation dating back to over a century ago,⁷ widespread adoption did not occur until more recent randomized trials demonstrated benefits for patients who failed to liberate from mechanical ventilation, as well as patients with flail chest and those with significant non-flail patterns of rib fractures.^8–10 These data supported more routine use of surgical stabilization of rib fractures (SSRF)^8,10 in contemporary trauma practice, leading to the formation of the Chest Wall Injury Society (CWIS) and the publication of national guidelines.^11,12

In addition to patient selection, the timing of SSRF has become an important area of investigation. Multiple studies have demonstrated improved outcomes when SSRF is performed within 72 h of arrival, including reduced hospital length of stay (LOS), fewer ventilator days, and lower rates of pneumonia and tracheostomy.^13,14 As such, CWIS guidelines recommend SSRF to be performed within 72 h when feasible.¹¹ However, there have not been any recent studies examining national trends in SSRF rates, including timing of SSRF, since these guidelines were developed.

Therefore, this study aimed to evaluate how the timing and rates of SSRF have changed in recent years (2017-2023) for isolated blunt chest trauma patients and whether this has impacted outcomes including LOS. We hypothesized there would be an increase in the overall rate of SSRF over this time period, with a specific increase in early SSRF (≤72 h from arrival) in 2023 compared to the pre-guideline period of 2017.

Methods

The 2017-2023 TQIP database was queried for all patients 18 years of age and older presenting with ≥2 rib fractures. Patients with an abbreviated injury scale (AIS) grade <2 in non-chest regions (head, face, spine, and abdomen) were included to delineate a near-isolated blunt chest trauma cohort, excluding patients with AIS ≥2 injuries in these regions, as concomitant injuries may delay or preclude SSRF. This was done using International Classification of Disease, 10^th Revision codes (ICD-10) which are included in a separate appendix. We did not incorporate AIS thorax into our analysis for the following reasons: first, we excluded patients by number of rib fractures and second, AIS thorax was clinically similar (albeit statistically different) across the study period with a median of 3 (interquartile range 3-3) in each year.

The primary outcome was the annual rate of SSRF from 2017 to 2023. Patients were stratified by and compared across years. Additional planned analyses were performed where patients were stratified by timing of SSRF and compared across years from 2017 to 2023. Early SSRF was defined as ≤72 h from hospital arrival, intermediate SSRF as >72 to ≤120 h from arrival, and late SSRF as >120 h from arrival. Additional variables evaluated included the median age of patients and median total hospital LOS across the study period. Some patients were missing data for LOS and timing of operation and were excluded for those respective analyses.

Bivariate analyses were performed using chi-square tests to compare categorical variables. Continuous variables were compared across years using the Kruskal-Wallis test, given non-normal distributions and reporting of medians with interquartile range. Chi-square analysis was also used to assess variation over time. Logistic regression analysis using year as a predictor was additionally performed to assess trends over time for SSRF rates. Categorical data were reported as percentages, and continuous data were reported as medians with interquartile range (IQR). SSRF rates were calculated percentages of the total isolated blunt chest trauma cohort and of the proportion of all SSRF patients each year. All P-values were two-sided, with a statistical significance level of <0.05. All statistical analyses were performed using IBM SPSS Statistics for Windows (Version 31, IBM Corp., Armonk, NY). This study was deemed exempt by our institutional review board as it utilizes a national deidentified database.

Results

From 2017 to 2023, there were 371 193 near-isolated blunt chest trauma patients included. Of those, 17 966 (4.8%) underwent SSRF. The median AIS thorax across each year from 2017 to 2023 was 3 (IQR 3-3, P < 0.001). There was significant variation in the proportion of patients undergoing SSRF over the study period, with rates rising from 3.5% (n = 1594) in 2017 to 5.5% (n = 3435) in 2023 (P < 0.001) (Table 1). This increase represented a nearly 60% relative rise in SSRF utilization over time. Logistic regression analysis demonstrated that the odds of undergoing SSRF increased 7.8% per year (OR 1.078, 95% CI 1.070-1.086; P < 0.001). When stratified by timing of surgery, both early and intermediate SSRF showed significant variation over the study period. Early SSRF increased from 1.8% in 2017 to 3.4% in 2023 (P < 0.001), while intermediate SSRF increased from 0.9% to 1.3% during the same period (P < 0.001). In contrast, late SSRF remained stable, with no significant change from 2017 to 2023 (0.8% vs 0.8%, P = 0.25) (Table 2). When compared as a proportion of all the SSRF cases performed each year, early SSRF increased over time (2017: 52.4%; 2023: 61.8%, P < 0.001), whereas late SSRF decreased over time (2017: 22.1%; 2023: 14.7%, P < 0.001). Intermediate timing of SSRF did not show any significant variation over time (2017: 25.5%; 2023: 23.4%, P = 0.738) (Table 3). On logistic regression analyses for each timing group of SSRF, the odds of undergoing early SSRF increased 10.4% per year (OR 1.104, 95% CI 1.093-1.115; P < 0.001). The odds of undergoing intermediate SSRF increased 6.4% per year (OR 1.064, 95% CI 1.047-1.080; P < 0.001). For late SSRF, there was no significant association with year (OR 1.008, 95% CI 0.990-1.026; P = 0.393). These findings indicate that the overall rise in SSRF was primarily driven by earlier operative intervention.

Table 1.

Changes in Rates of SSRF Cases After Isolated Blunt Chest Trauma, 2017 to 2023

	Year
	2017 (n = 45 370)	2018 (n = 47 398)	2019 (n = 49 902)	2020 (n = 49 774)	2021 (n = 56 612)	2022 (59 511)	2023 (n = 62 626)	P-value
SSRF, n (%)	1594 (3.5%)	1901 (4.0%)	2128 (4.3%)	2635 (5.3%)	3049 (5.4%)	3224 (5.4%)	3435 (5.5%)	<0.001

SSRF: surgical stabilization of rib fractures. The bold font for the p-value is to show that it is statistically significant.

Table 2.

Changes in Rates of SSRF After Blunt Chest Trauma Stratified by Timing From 2017 to 2023

	Year
Timing of SSRF	2017 (n = 45 370)	2018 (n = 47 398)	2019 (n = 49 902)	2020 (n = 49 774)	2021 (n = 56 612)	2022 (n = 59 511)	2023 (n = 62 626)	P-value
≤72 h, n (%)	830 (1.8%)	1060 (2.2%)	1198 (2.4%)	1576 (3.2%)	1818 (3.2%)	1990 (3.3%)	2116 (3.4%)	<0.001
>72 to ≤120 h, n (%)	404 (0.9%)	463 (1.0%)	523 (1.0%)	619 (1.2%)	725 (1.3%)	762 (1.3%)	802 (1.3%)	<0.001
>120 h, n (%)	350 (0.8%)	365 (0.8%)	390 (0.8%)	428 (0.9%)	495 (0.9%)	460 (0.8%)	505 (0.8%)	0.257

SSRF: surgical stabilization of rib fractures. Some patients were excluded due to lack of data on timing of surgery. The bold font for the p-value is to show that it is statistically significant.

Table 3.

Changes in Rates of SSRF After Blunt Chest Trauma Stratified by Timing From 2017 to 2023, as Proportions of All SSRF Cases

	Year
Timing of SSRF	2017 (n = 1584)	2018 (n = 1888)	2019 (n = 2111)	2020 (n = 2623)	2021 (n = 3038)	2022 (n = 3212)	2023 (n = 3423)	P-value
≤72 h, n (%)	830 (52.4%)	1060 (56.1%)	1198 (56.7%)	1576 (60.1%)	1818 (59.8%)	1990 (62.0%)	2116 (61.8%)	<0.001
>72 to ≤120 h, n (%)	404 (25.5%)	463 (24.5%)	523 (24.8%)	619 (23.6%)	725 (23.9%)	762 (23.7%)	802 (23.4%)	0.738
>120 h, n (%)	350 (22.1%)	365 (19.3%)	390 (18.5%)	428 (16.3%)	495 (16.3%)	460 (14.3%)	505 (14.7%)	<0.001

SSRF: surgical stabilization of rib fractures. The bold font for the p-value is to show that it is statistically significant.

There were significant differences in the median age of blunt chest trauma patients undergoing SSRF over the years, increasing from a median of 58 years of age in 2017 to 61 years in 2023 (P < 0.001) (Table 4). The median overall LOS varied over time with a decrease from 2017 to 2023 (12 [IQR: 8-17] days [2017]; 11 [IQR: 8-16] days [2023]; P < 0.001) (Figure 1). After stratifying SSRF patients by timing of surgery, median LOS did not vary significantly over time within any timing group. For early SSRF, median LOS remained 9 days (IQR 7-13) across all years (P = 0.845). Similarly, there were no significant changes in LOS among patients undergoing intermediate SSRF (median 12 days, IQR 9-17; P = 0.188) or late SSRF (median 17-18 days, IQR 13-24; P = 0.324). In contrast, median patient age increased significantly over time in all three timing cohorts, including early SSRF (57 to 61 years, P < 0.001), intermediate SSRF (58 to 61 years, P = 0.004), and late SSRF (60 to 62 years, P < 0.001) (Table 5).

Table 4.

Median Age and Median LOS of Isolated Blunt Chest Trauma Patients Undergoing SSRF by Year From 2017 to 2023

	Year
	2017 (n = 1594)	2018 (n = 1901)	2019 (n = 2128)	2020 (n = 2635)	2021 (n = 3049)	2022 (n = 3224)	2023 (n = 3435)	P-value
Median age, day (IQR)	58 (48-68)	58 (48-68)	59 (49-69)	58 (48-68)	59 (49-69)	60 (49-70)	61 (50-71)	<0.001

	(n = 1576)	(n = 1892)	(n = 2117)	(n = 2625)	(n = 3037)	(n = 3220)	(n = 3431)
Median LOS, day (IQR)	12.0 (8.0-17.0)	11.0 (8.0-16.0)	11.0 (8.0-16.0)	11.0 (8.0-16.0)	11.0 (8.0-16.0)	11.0 (8.0-16.0)	11.0 (8.0-16.0)	<0.001

SSRF: surgical stabilization of rib fractures; LOS: length of stay; IQR = interquartile range. The bold font for the p-value is to show that it is statistically significant.

Figure 1.

Hospital length of stay in patients undergoing SSRF by year from 2017 to 2023. P < 0.001. SSRF: surgical stabilization of rib fractures; LOS: length of stay

Table 5.

Median Hospital LOS and Median Age for Isolated Blunt Chest Trauma Patients Undergoing SSRF by Year From 2017 to 2023 Stratified by Timing of Surgery

	2017 (n = 1566)	2018 (n = 1880)	2019 (n = 2100)	2020 (n = 2613)	2021 (n = 3029)	2022 (n = 3208)	2023 (n = 3419)	P-value
SSRF ≤72 h	n = 820	n = 1054	n = 1190	n = 1569	n = 1811	n = 1988	n = 2114
LOS, d (IQR)	9.0 (7.0-13.0)	9.0 (7.0-13.0)	9.0 (7.0-13.0)	9.0 (7.0-12.0)	9.0 (7.0-13.0)	9.0 (7.0-13.0)	9.0 (7.0-13.0)	0.845
Age, y (IQR)	57.0 (47.75-68.0)	59.0 (48.0-68.0)	59.0 (49.0-68.0)	59.0 (48.0-69.0)	60.0 (49.0-69.0)	60.0 (50.0-70.0)	61.0 (50.0-71.0)	<0.001
SSRF >72 to ≤120 h	n = 402	n = 462	n = 522	n = 617	n = 725	n = 761	n = 800
LOS, d (IQR)	12.0 (9.0-17.0)	12.0 (10.0-17.0)	12.0 (9.0-17.0)	12.0 (9.0-15.0)	12.0 (9.0-16.0)	12.0 (9.0-17.0)	12.0 (9.0-17.0)	0.188
Age, y (IQR)	58.0 (47.0-68.0)	57.0 (47.0-67.0)	59.0 (47.0-68.0)	58.0 (47.0-67.0)	59.0 (49.0-68.0)	60.0 (50.0-70.0)	61.0 (49.0-70.0)	0.004
SSRF >120 h	n = 344	n = 364	n = 388	n = 427	n = 493	n = 459	n = 505
LOS, d (IQR)	17.0 (14.0-24.0)	18.0 (14.0-23.0)	17.0 (13.0-23.0)	18.0 (14.0-25.0)	17.0 (13.0-24.0)	17.0 (13.0-23.0)	18.0 (13.0-24.0)	0.324
Age, y (IQR)	60.0 (48.0-69.0)	58.0 (46.5-67.0)	59.0 (49.0-70.0)	57.0 (48.0-67.8)	60.0 (47.0-68.0)	60.0 (49.0-69.0)	62.0 (50.0-71.0)	<0.001

SSRF: surgical stabilization of rib fractures. LOS = length of stay, IQR = interquartile range, d = days, y = years.

No patients were excluded for the age analysis; the n above refers to the LOS analysis. The bold font for the p-value is to show that it is statistically significant.

Discussion

Rib fractures remain a frequent and morbid injury following blunt chest trauma, and SSRF has become an increasingly utilized operative strategy for select patients. In this national analysis of isolated blunt chest trauma patients, we found a nearly 60% relative increase in SSRF utilization from 2017 to 2023, driven largely by growth in early and intermediate fixation, alongside a progressively older operative cohort and a modest reduction in hospital LOS. When evaluating SSRF within each year, the proportion of early SSRF increased, whereas the proportion of late SSRF decreased. Overall, these findings suggest evolving national practice patterns that parallel published evidence and guideline recommendations regarding both patient selection and timing of SSRF.

At times, surgical procedures may have increased research but not receive widespread adoption due to cost, technical challenges, and/or other potential barriers.¹⁵ Prior to 2017, one study using the National Trauma Database (NTDB) demonstrated an over 35% increase in SSRF utilization from 2007 to 2014, with the overall rate of SSRF performed during the study period being 4.3%.¹⁶ Our more contemporary analysis following the publication of recent guidelines in 2017¹² found a more than 50% increase in the national rate of SSRF for near-isolated blunt chest trauma during the study period. This is similar to findings by Zangbar et al across 2017-2021.¹⁷ This is likely due to a combination of factors including increased research on the short and long-term benefits of SSRF,^16,18 as well as the improved fidelity of existing hardware and increased opportunities for education led by industry as well as societies such as CWIS.⁷ Additionally, there are multiple studies now demonstrating safety and benefit of SSRF in older adults,^6,19 which likely led to the increasing age of the cohort in our study as well other reports.^19,20

With increasing adoption of SSRF, there has also been increased discussion regarding the optimal timing of SSRF. Several studies, including but not limited to the Eastern Association for the Surgery of Trauma (EAST) and CWIS guidelines, recommend performing SSRF as early as possible, with CWIS recommending within 3 days of arrival.^11–14 While a 2018 multicenter prospective study found an increase in both overall SSRF cases and early SSRF (<24 h) cases from 2006 to 2016,¹³ there are no recent studies assessing national changes in practice patterns relating to SSRF timing. By stratifying TQIP patients by timing, this current study found that from 2017 to 2023, early (≤72 h) and intermediate SSRF (>72 to ≤ 120 h) increased significantly. On the other hand, late SSRF (>120 h from arrival) remained stable during the study period. When each category (early, intermediate, and late) is evaluated as a proportion of overall SSRF for each specific year, early SSRF increased and late SSRF decreased over time. Overall, this highlights alignment of practices with recent evidence and published national guidelines supporting early SSRF.

While much of the current evidence shows that patients undergoing SSRF have a shorter overall and/or intensive care unit LOS when compared with patients undergoing nonoperative management,^8,10,12,21 some research has shown equivalent or longer LOS with SSRF.²² A prior single-center, decade-long retrospective study found that their hospital LOS improved by more than half over the study period (19 vs 9 days, P < 0.001).²³ Our study found a more modest one-day decrease in LOS over time on a national level for near-isolated blunt chest trauma patients undergoing SSRF. After stratifying by timing of SSRF, there was no significant variation in LOS in any of the three groups individually, suggesting that the observed reduction is likely due to small but not statistically significant improvements in each category related to perioperative care. This decline in LOS over the years appears predominantly related to initial improvements between 2017 and 2018 (Figure 2) which then plateaued. This highlights one of the potential benefits of the continued advancement of SSRF and suggests an opportunity for continued development of enhanced recovery pathways associated with this surgical procedure, which may further reduce LOS following SSRF.`

Figure 2.

Median age of patients undergoing SSRF by year from 2017 to 2023. P < 0.001. SSRF: surgical stabilization of rib fractures

This study is limited by multiple factors inherent to large national database studies, namely, a risk of misclassification as well as selection and reporting bias. Additionally, our results do not capture the full extent of SSRF cases performed nationally, as we excluded the majority of polytrauma patients who underwent SSRF (eg, AIS ≥2 in non-chest regions). The TQIP also only includes patients with a minimum Injury Severity Score of 9. Therefore, the results may not be generalizable to all blunt trauma patients. In addition, our study lacks granular details related to the injury profiles (ie, Rib Score and flail vs non-flail), indications for the SSRF, and other pertinent factors including pain scores, analgesia and adjuncts including epidural catheters, peripheral blocks, and nerve cryoablation^18,24 surgeon experience, and type of SSRF system used. Though there is significant variation of the median LOS over time, there is an inflection point earlier in the study period than 2023. Our statistical analysis did not take into account hospital variations, AIS thorax scores, comorbid conditions, or mechanisms of injury which may affect decisions related to SSRF. Lastly, our study did not exclude patients with AIS ≥2 in upper or lower extremities, which can include some pelvic fractures. The omission of these variables could potentially lead to bias due to delays in operative timing. Despite these limitations, this study is strengthened by its large power and inclusion of centers across the country thus providing increased generalizability of its findings.

Conclusions

This national analysis spanning 7 years of data demonstrates a nearly 60% relative national increase in SSRF from 2017 to 2023, with a progressively older cohort of near-isolated blunt trauma patients undergoing SSRF. This increase was primarily driven by greater use of early and intermediate fixation, while rates of late SSRF remained unchanged. In parallel, a progressively older patient population underwent SSRF, and a small reduction in overall hospital LOS was observed over time. Together, these findings suggest increasing national alignment with contemporary evidence and guideline recommendations favoring earlier SSRF.

Supplemental Material

Supplemental material - National Changes in Timing and Rates of Surgical Stabilization of Rib Fractures (SSRF): SSRF Occurring Early and More Often

Supplemental material for National Changes in Timing and Rates of Surgical Stabilization of Rib Fractures (SSRF): SSRF Occurring Early and More Often by Michael J de Virgilio, MD, Areg Grigorian, MD, Peter D Nguyen, MD, Sebastian Schubl, MD, Mallory Jebbia, MD, Jacob Kirkorowicz, MD, Hanaan Salamah, MD, Catherine Kuza, MD, Jeffry Nahmias, MD, MHPE in The American Surgeon™

Footnotes

ORCID iDs

Michael J de Virgilio

Peter D Nguyen

Mallory Jebbia

Author Contributions

All authors contributed to the study conception and design. Analysis was performed by Areg Grigorian. The first draft of the manuscript was written by Michael J de Virgilio, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Funding

Dr. Sebastian Schubl is an education consultant for and receives royalties from Zimmer-Biomet. The remaining authors report that there are no financial disclosures.

Declaration of Conflicting Interests

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

Meetings

Presented at 2026 Southern California Chapter, American College of Surgeons Annual Meeting, January 11, 2026, Santa Barbara, CA.

Supplemental Material

Supplemental material is available online.

References

Ziegler

Agarwal

. The morbidity and mortality of rib fractures. J Trauma. 1994;37(6):975-979.

Sirmali

Türüt

Topçu

, et al. A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardio Thorac Surg. 2003;24(1):133-138.

Sharma

Oswanski

Jolly

Lauer

Dressel

Stombaugh

. Perils of rib fractures. Am Surg. 2008;74(4):310-314.

Bulger

Arneson

Mock

Jurkovich

. Rib fractures in the elderly. J Trauma. 2000;48(6):1040-1046. discussion 1046-1047.

Stawicki

Grossman

Hoey

Miller

Reed

3rd . Rib fractures in the elderly: a marker of injury severity. J Am Geriatr Soc. 2004;52(5):805-808.

Sarani

Pieracci

. Contemporary management of patients with multiple rib fractures: what you need to know. J Trauma Acute Care Surg. 2024;97(3):337-342.

Shaban

Frank

Schubl

, et al. The history of surgical stabilization of rib fractures (SSRF). Surgery in Practice and Science. 2022;10:100084.

Granetzny

Abd El-Aal

Emam

Shalaby

Boseila

. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact Cardiovasc Thorac Surg. 2005;4(6):583-587.

Pieracci

Leasia

Bauman

, et al. A multicenter, prospective, controlled clinical trial of surgical stabilization of rib fractures in patients with severe, nonflail fracture patterns (chest wall injury society NONFLAIL). J Trauma Acute Care Surg. 2020;88(2):249-257.

10.

Tanaka

Yukioka

Yamaguti

, 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. discussion 732.

11.

Bauman

Tian

Doben

, et al. Chest wall injury society guidelines for surgical stabilization of rib fractures: indications, contraindications, and timing. J Trauma Acute Care Surg. 2025;99(4):522-532.

12.

Kasotakis

Hasenboehler

Streib

, 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.

13.

Pieracci

Coleman

Ali-Osman

, et al. A multicenter evaluation of the optimal timing of surgical stabilization of rib fractures. J Trauma Acute Care Surg. 2018;84(1):1-10.

14.

Lagazzi

Rafaqat

Argandykov

, et al. Timing matters: early versus late rib fixation in patients with multiple rib fractures and pulmonary contusion. Surgery. 2024;175(2):529-535.

15.

Sutherland

Shepherd

Kinslow

McKenney

Elkbuli

. REBOA use, practices, characteristics, and implementations across various US trauma centers. Am Surg. 2022;88(6):1097-1103.

16.

Kane

Jeremitsky

Pieracci

Majercik

Doben

. Quantifying and exploring the recent national increase in surgical stabilization of rib fractures. J Trauma Acute Care Surg. 2017;83(6):1047-1052.

17.

Zangbar

Rafieezadeh

Kirsch

Lin

Prabhakaran

. National trend of surgical stabilization of rib fractures: indications, approaches, and disparities. J Surg Res. 2024;303:691-698.

18.

Stopenski

Binkley

Schubl

Bauman

. Rib fracture management: a review of surgical stabilization, regional analgesia, and intercostal nerve cryoablation. Surg Pract Sci. 2022;10:100089.

19.

Pieracci

Leasia

Hernandez

, et al.

Surgical stabilization of rib fractures in Octogenarians and beyond-what are the outcomes?

J Trauma Acute Care Surg. 2021;90(6):1014-1021.

20.

Zangbar

Mehta

Prabhakaran

, et al.

Rib fractures in frail geriatric patients: does surgical stabilization improve outcomes?

J Trauma Acute Care Surg. 2026;100(1):40-46.

21.

Liang

Wong

Kao

Tiong

Tam

. 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.

22.

Kwon

Zakhary

Coimbra

Sarani

Coimbra

. Early surgical stabilization of multiple rib fractures and flail chest is associated with better outcomes compared with nonoperative management. J Trauma Acute Care Surg. 2025;99(6):859-867.

23.

Prins

JTH

Leasia

Sauaia

, et al. A decade of surgical stabilization of rib fractures: the effect of study year on patient selection, operative characteristics, and in-hospital outcome. Injury. 2022;53(5):1637-1644.

24.

Nahmias

Stopenski

Jebbia

, et al. Dexmedetomidine for analgesia in nonintubated patients with traumatic rib fractures: a randomized clinical trial. JAMA Surg. 2025;160(10):1047-1056.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.09 MB

0.00 MB