• Reinier B Beks, Mirjam B de Jong, Arthur Sweet, Jesse Peek, Bas van Wageningen, Tjarda Tromp, Frank IJpma, Roderick Wouters, Koen Lansink, Mike Bemelman, Mark van Baal, Jochem Hoogendoorn, Teun Saltzherr, Rolf Groenwold, Luke Leenen, and Roderick Marijn Houwert.
• Trauma Surgery, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands reinierbeks@gmail.com.
• BMJ Open. 2019 Aug 27; 9 (8): e023660.

IntroductionA trend has evolved towards rib fixation for flail chest although evidence is limited. Little is known about rib fixation for multiple rib fractures without flail chest. The aim of this study is to compare rib fixation with nonoperative treatment for both patients with flail chest and patients with multiple rib fractures.Methods And AnalysisIn this study protocol for a multicentre prospective cohort study, all patients with three or more rib fractures admitted to one of the five participating centres will be included. In two centres, rib fixation is performed and in three centres nonoperative treatment is the standard-of-care for flail chest or multiple rib fractures. The primary outcome measures are intensive care unit length of stay and hospital length of stay for patients with a flail chest and patients with multiple rib fractures, respectively. Propensity score matching will be used to control for potential confounding of the relation between treatment modality and length of stay. All analyses will be performed separately for patients with flail chest and patients with multiple rib fractures without flail chest.Ethics And DisseminationThe regional Medical Research Ethics Committee UMC Utrecht approved a waiver of consent (reference number WAG/mb/17/024787 and METC protocol number 17-544/C). Patients will be fully informed of the purpose and procedures of the study, and signed informed consent will be obtained in agreement with the General Data Protection Regulation. Study results will be submitted for peer review publication.Trial Registration NumberNTR6833.© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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