Abstract
Abstract Flail chest represents a severe form of blunt thoracic trauma and is defined by fractures of three or more consecutive ribs in at least two locations, resulting in paradoxical chest wall motion. This condition significantly disrupts normal respiratory mechanics and is associated with increased morbidity and mortality, particularly in elderly patients and those with pre-existing pulmonary disease. Management strategies remain controversial, with both operative rib fixation and conservative treatment widely practiced worldwide. This study aimed to evaluate and compare the clinical outcomes of surgical rib fixation versus conservative management in patients with flail chest, focusing on overall mortality, duration of mechanical ventilation, ICU length of stay, and complication rates including pneumonia. A retrospective cohort study was conducted including 72 patients diagnosed with flail chest and admitted to the ICU between March 2019 and April 2023. Patients were divided into a surgical fixation group and a conservative treatment group. Clinical outcomes were assessed and statistically compared between the two groups. Patients who underwent rib fixation demonstrated significantly shorter ICU stays (mean 7 days) compared to those treated conservatively (mean 12 days). Additionally, surgical fixation was associated with a decreased duration of mechanical ventilation (3 vs 7 days), lower incidence of pneumonia (9% vs 22%), and reduced mortality (7% vs 10%). Propensity score matching confirmed that rib fixation was independently associated with improved outcomes. Surgical rib fixation in flail chest patients offers significant clinical advantages, including reduced ICU length of stay, mechanical ventilation duration, and complication rates, compared with conservative management. Larger multicenter randomized controlled trials are warranted to validate these findings and to investigate long-term functional outcomes, pain control, and quality of life.