Hybrid versus single internal fixation strategies in minimally invasive surgery for multiple rib fractures: a...

Surgical stabilization of rib fractures typically employs a single type of internal fixation material. While this "Single Strategy" offers the advantage of procedural consistency and facilitates a rapid learning curve for surgeons, it often fails to address the heterogeneity of multiple rib fractures (MRF). Factors such as fracture location, segment length, degree of comminution, and associated intrathoracic visceral injuries frequently render a single material insufficient for all fracture types within a single patient. Consequently, we adopted a clinical approach utilizing multiple fixation materials tailored to specific fracture characteristics. To date, systematic implementation of such a "Hybrid Fixation Strategy" has not been widely reported. This study aims to evaluate the safety and feasibility of this multi-material approach in patients with MRF.

A retrospective, controlled, observational study was conducted on patients with MRF and flail chest treated between 2020 and 2024. A total of 316 patients were included and stratified into two groups. The Hybrid Group (n = 128) consisted of consecutive patients treated with a combination of at least two types of internal fixation materials (specifically locking plates and rib clamps) based on anatomical requirements. The Single Group (n = 188) was treated using a single fixation material. Perioperative efficiency, safety profiles, and clinical outcomes were compared to assess feasibility.

The Hybrid Group demonstrated superior feasibility and efficiency, with significantly shorter operative times (94.72 ± 15.46 vs. 147.53 ± 31.04 min, P < 0.001) and reduced intraoperative blood loss (213.40 ± 83.19 vs. 298.60 ± 115.96 mL, P < 0.001) compared to the Single Group. Regarding safety, there was no significant difference in the overall incidence of postoperative complications between the two groups (P > 0.05). Additionally, patients in the Hybrid Group achieved earlier ambulation (1.16 ± 0.39 vs. 2.44 ± 1.13 days, P < 0.001), indicating enhanced postoperative recovery.

The application of multiple internal fixation materials (Hybrid Strategy) is a safe and feasible technique for managing complex MRF. By addressing the limitations of single-material fixation through site-specific adaptation, this strategy improves surgical efficiency and stability without compromising safety. While these results are promising, further studies with larger sample sizes are warranted to validate these findings.