Current and Emerging Techniques for Surgical Stabilisation of Rib Fractures: A Systematic Scoping Review

Surgical stabilisation of rib fractures in select patients is shown to significantly improve outcomes. However, there is considerable variation in surgical techniques necessitating a comprehensive analysis of current practices.

The MEDLINE, EMBASE, Cochrane Library Compendex, Proquest, Scopus, and IEEE databases were systematically searched for studies across four time periods P1(2000-2006), P2(2007-2011), P3(2012-2016), and P4(2017-2021). SSRF Techniques of fixation were assessed and classified by design principles. Variation in approach, indications, and postoperative complications of different systems were described.

A total of 132 clinical studies with a pooled population of 6816 were described. A further 22 pre-clinical studies were included. Numerous emerging techniques were identified in the pre-clinical literature. Established techniques of fixation with clinical data include: plating with screw fixation (n = 87 of 132 studies), plating with clip fixation (19/132), intramedullary implants (2/132), bioresorbable devices (7/132), and others. Evidence mapping showed a growing pool of clinical data for plating with screw fixation and highlights the paucity of data available for other devices preventing formal statistical comparisons of postoperative outcomes between fixation systems.

There is a wide range of techniques described for surgical stabilisation of unstable rib fractures, with the number of clinical studies published increasing. There is a geographical variation in the techniques described, and a burgeoning interest in minimally invasive rib fixation. Comparative studies and pooled data are uncommon. As interest in this field grows, there is a need for multicentre collaborative studies and refinement of indications for SSRF.