An Overview of Meta-Analyses on the Surgical Stabilization of Rib Fractures in Adults: A Narrative Umbrella Review
Maria Chiara Sibilia1,2, Francesca Romboni1,2, Sara Franzi2
1Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy.
Abstract:
Background: Rib fractures are a common cause of morbidity in trauma patients. The surgical stabilization of rib fractures (SSRF) has gained increasing attention as a therapeutic option; however, evidence from multiple meta-analyses remains heterogeneous. Methods: We performed an overview of 11 meta-analyses, including a total of 1,117,849 adult patients (narrative umbrella review), published between November 2020 and November 2025 to summarize and critically appraise high-level evidence comparing SSRF with non-operative management (NOM) in adults with traumatic rib fractures. PubMed (MEDLINE) and Embase were searched for eligible meta-analyses. Outcomes of interest included mechanical ventilation duration, pneumonia, ICU and hospital length of stay, mortality, pain, quality of life, and need for tracheostomy. Results: Eleven meta-analyses met the inclusion criteria. Across outcomes, the direction of effect generally favored SSRF in selected patients, particularly with respect to a shorter duration of mechanical ventilation (mean difference up to approximately 4-6 days), reduced pulmonary complications (risk ratio approximately 0.4-0.7), shorter ICU and hospital stay, and improved pain control. However, results varied substantially across studies. A consistent mortality benefit was not observed. Subgroup analyses suggested that the benefits of SSRF were more pronounced in patients with flail chest, severe fracture patterns, and early surgery, whereas findings were less consistent in elderly patients and in patients with less severe injuries. Conclusions: This narrative umbrella review suggests that SSRF is associated with improved short-term outcomes in selected adult patients with traumatic rib fractures but should not be considered a universal standard of care. Careful patient selection, timing of intervention, and multidisciplinary evaluation remain essential. Further high-quality prospective studies are needed to better define optimal indications and management strategies.
