Severe thoracic trauma is a common cause of chest injury. Patients with severe thoracic trauma combined with rib fractures who fail to receive effective treatment in time may develop complications such as a haemothorax and pneumothorax, which may seriously affect their prognosis .
In the past, conservative treatments for severe thoracic trauma with rib fractures was common, but the therapeutic effect was not satisfactory . For patients treated non-surgically, although mechanical ventilation and external chest fixation partially relieved the pathophysiological changes caused by abnormal breathing and pulmonary contusions, these methods could not completely eliminate their abnormal breathing so mild activity could lead to severe pain; patients treated non-surgically need more potent analgesic drugs and cannot cope with coughing to expel the easily formed airway secretions, which can cause hypoxemia, severe pulmonary infections, atelectasis and other lung complications . Meanwhile, the chest wall still has varying degrees of softening and collapse, and misplaced rib fractures can lead to thoracic deformities that affect appearance or even result in damage to the intercostal blood vessels and nerves .
In recent years, the method of open reduction and internal fixation for severe thoracic trauma combined with rib fractures has been widely used . Studies have shown that 72 h after operation of a rib fracture, the pain caused by the friction between the broken ends of the fractures is reduced, the effect of mediastinal oscillate on the cardiovascular circulation is eliminated, the patient’s respiratory movement changes from shallow to normal, and the haemodynamics are significantly improved. Meanwhile, during general anaesthesia, the lung tissue showed good swelling, lung ventilation was improved, and management of the respiratory tract can effectively remove respiratory secretions in the acute phase . Therefore, in some patients with mild pulmonary contusions, extubation was performed immediately following recovery from anaesthesia without the need for mechanical support. Surgically treated patients did not need external fixation and were not restricted in respiratory activity. Surgically treated patients could cough, turn over independently and get out of bed earlier than non-surgically treated patients. These activities are conducive to maintaining airway patency and reducing lung complications. As a result, the duration and use of mechanical ventilation in the surgical management group were significantly reduced, and there were clear advantages in pain control . These reported results are consistent with the research results in this paper.
This meta-analysis presents results from 14 studies comparing surgical approaches to non-surgical approaches for the treatment of rib fractures [6,7,8,9,10,11,12,13,14,15,16,17,18,19]. We conclude that surgical intervention decreased the duration of hospitalization time, intensive care time, and mechanical ventilation time, lowered the odds for needing a tracheotomy and contracting a pulmonary infection, and reduced the mortality rate, as compared to non-surgical management.
In addition, many studies have shown the advantages of using surgical treatment for rib fractures. For example, Tanaka A. et al.  reported that through open reduction and internal fixation of rib fractures, the fractured end can reach anatomical reduction. Abnormal breathing disappears immediately after surgery, and the thorax restores its original shape and function, thereby greatly reducing the rate of tracheotomy. Moreover, surgical management can reduce the compression and stimulation of fractured intercostal nerves and effectively relieve respiratory pain so the airway secretions can be more easily coughed up; these factors will promote self-discharge, improve respiratory function, reduce the incidence of pulmonary complications, shorten the hospital stay, and improve the patient’s quality of life . Treating multiple rib fractures with open reduction and internal fixation has been shown to be a more scientific and rational treatment method, especially for patients with serious fracture dislocations .
This study also has some limitations. It is difficult to design high-quality studies on the effect of surgical management on the outcomes of rib fractures because the participants could not be randomly assigned to exposure groups, and blinding is only partially possible. We chose to include all comparative studies in this systematic review since that represented the best evidence available at present. The differentiation between retrospective and prospective trials can be difficult because many authors present a study with prospective data collection and retrospective analysis of the data as being prospective in design. Scoring of the methodology, however, showed that the studies included in this review were comparable and that pooling the studies was therefore justifiable.