A Multicenter Randomized Controlled Trial on the Surgery of Fractured Ribs: The SOFRIB Trial.
Darwin Ang1,2,3, Avery Nathens4, Donna Nayduch5
1University of South Florida, Tampa, Florida.
Annals of Surgery
|March 26, 2026
Summary
Surgical stabilization of rib fractures (SSRF) did not reduce intensive care unit stays but improved patient quality of life and pain. Findings suggest selective, not routine, SSRF for significant rib fractures.
Area of Science:
- Trauma Surgery
- Critical Care Medicine
- Orthopedic Surgery
Background:
- Rib fractures are common in blunt trauma, causing significant morbidity and healthcare costs.
- Surgical stabilization of rib fractures (SSRF) is established for flail chest but its broader application is unclear.
Purpose of the Study:
- To determine if SSRF improves acute and patient-centered outcomes in adults with significant rib fractures.
Main Methods:
- A multicenter randomized controlled trial (SOFRIB) compared SSRF to non-operative care in adults with ≥3 displaced rib fractures.
- Primary outcome was ICU length of stay; secondary outcomes included hospital LOS, pneumonia, pulmonary function, pain, and quality of life.
Main Results:
- SSRF did not significantly reduce ICU length of stay (1.8 days difference, P=0.17).
- SSRF was linked to longer hospital LOS (+3.3 days, P=0.01) and increased pneumonia rates (11.4% vs. 3.3%, P=0.02).
- SSRF improved quality of life (SF-36) and reduced pain impact (PIQ-6), with more frequent return-to-work (62.5% vs. 38.7%, P=0.08).
Conclusions:
- Routine SSRF did not decrease ICU stay but improved patient-reported outcomes.
- The study supports a selective approach to SSRF rather than routine application for significant rib fractures.
Keywords:
Conservative treatmentLevel 1-2 Trauma centersMulticenterRandomized Clinical TrialRib Fracture FixationThoracic TraumaMore Related Videos
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