Comparative Outcomes of Surgical Stabilization and Nonoperative Management for Rib Fractures: A Quasi-experimental...

Rib fractures are among the most common injuries in blunt thoracic trauma and are associated with significant morbidity due to respiratory compromise, pain, and pulmonary complications. While nonoperative management remains the traditional approach, surgical stabilization of rib fractures (SSRF) has gained attention for improving outcomes in patients with multiple displaced rib fractures and flail chest. This study aimed to compare the clinical and functional outcomes of SSRF vs. nonoperative management in patients with multiple rib fractures at a Level I Trauma Center in Eastern India.

A quasi-experimental study was conducted from January 2023 to December 2024, including 58 patients aged 18-70 years with multiple displaced rib fractures or flail chest. Patients were divided into two groups: Group A (n = 29) underwent surgical stabilization, and Group B (n = 29) received nonoperative management. Demographic variables, clinical outcomes, duration of hospital stay, ICU stay, ventilatory days, pain scores (Visual Analog Scale), functional outcomes, inflammatory markers, and complications were recorded. Statistical analysis was performed using the Statistical Package for the Social Sciences version 25 (IBM Corp., Armonk, NY), with p < 0.05 considered statistically significant.

Both groups were comparable in demographic characteristics, injury profile, and associated thoracic injuries. Patients in the SSRF group demonstrated significantly shorter hospital stay (9.21 ± 1.99 vs. 12.10 ± 1.52 days, p = 0.01), ICU stay (2.72 ± 0.88 vs. 4.24 ± 0.83 days, p = 0.01), and ventilatory duration (3.03 ± 1.15 vs. 5.38 ± 1.24 days, p = 0.01). Postoperative pain scores were significantly lower in the operative group at all follow-up intervals (p = 0.01). Functional recovery and quality-of-life scores showed progressive improvement in the surgical group. Chronic chest pain was significantly lower in the operative group (1 (3.4%) vs. 26 (89.7%), p = 0.01), with no mortality reported in either group.

SSRF significantly improves clinical outcomes by reducing hospital stay, ICU stay, ventilatory duration, pain severity, and chronic complications compared to nonoperative management. Despite limitations such as a nonrandomized design and a modest sample size, SSRF appears to be an effective treatment strategy for selected patients with multiple rib fractures and flail chest. Further randomized studies with larger sample sizes are recommended to validate these findings.