Comparison of flail and multiple simple rib fracture patterns among patients included in rib fracture studies; A systematic review and meta-analysis.

PURPOSE: Comparing baseline characteristics of patients with flail versus multiple simple rib fracture patterns, hypothesizing greater injury severity in the flail group.

METHODS

A systematic review of Cochrane Central, Embase, Medline Ovid, and Web of Science identified 66 cohorts from 1,799 records. Random effects models were used, with publication bias assessed via funnel plots. Primary outcome was injury severity score (ISS); secondary outcomes included number and level of fractured ribs and associated injuries.

RESULTS

Patients with flail fractures had significantly higher ISS (mean 27 vs 20; p < 0.05), more fractured ribs (mean 7 vs 4; p < 0.05), and more frequent pulmonary contusion (73 vs 42%), hemothorax (45 vs 20%), and in-hospital mortality (10 vs 2%; p < 0.05).

CONCLUSION

Flail chest fracture patterns indicate more severe trauma and higher complication rates. Studies should report outcomes for flail and multiple simple rib fracture patterns separately when evaluating rib fracture treatments.