Outcomes in Single Versus Two-Stage Surgical Stabilization of Complex Bilateral Chest Wall Injury: A Single-Center
Alexis A Schweibinz1, Jaya S Varre1, Anna Graham1
1Department of Surgery, Riverside Methodist Hospital (OhioHealth), Columbus, USA.
Cureus
|June 29, 2026
Summary
Surgical stabilization of severe rib fractures (SSRF) for bilateral chest wall injuries (CWI) can be performed in one or two stages. Staged repairs require more operative time and resources, with higher rates of pneumonia and tracheostomy.
Area of Science:
- Trauma Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Surgical stabilization of rib fractures (SSRF) improves outcomes for severe chest wall injury (CWI).
- Complex bilateral CWI presents unique clinical and technical challenges.
- Optimal surgical approach (single-stage vs. staged repair) for bilateral CWI remains undefined.
Purpose of the Study:
- To describe institutional experience with bilateral SSRF.
- Identify factors influencing single-stage vs. two-stage repair decisions.
- Assess benefits of combined bilateral SSRF in the index operation.
Main Methods:
- Retrospective review of patients with bilateral CWI undergoing SSRF (2018-2022).
- Exclusion criteria: unilateral fixation for bilateral CWI, CPR-related CWI.
- Analysis of patient/injury characteristics, operative details, and clinical outcomes (ventilator days, LOS, pneumonia, tracheostomy).
Main Results:
- 18 patients included (13 one-stage, 5 two-stage); all had flail chest.
- Two-stage repairs had higher Injury Severity Score (ISS), longer operative time, and required more plates.
- Staged repairs showed increased ventilator dependence, pneumonia, and tracheostomy rates.
Conclusions:
- Staged SSRF for bilateral CWI requires more operative time and resources.
- Findings suggest increased complexity and resource utilization in staged procedures.
- Individualized patient selection and resource planning are crucial for staged SSRF.
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