• Karolina Dahms, Jan Volmerig, Julia Dormann, Eva Steinfeld, Kelly Ansems, Heidrun Janka, Maria-Inti Metzendorf, and Carina Benstoem.
• Department of Intensive Care Medicine and Intermediate Care Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, D-52074, Aachen, Germany.
• Eur J Trauma Emerg Surg. 2025 Jan 24; 51 (1): 4545.

PurposeOsteosynthesis seems to have effects regarding clinical outcomes in trauma patients. However, current knowledge on chest wall osteosynthesis in polytrauma patients is insufficient, leaving its potential unanswered. Therefore, the objective of this systematic review is to assess the safety and effects of chest wall osteosynthesis compared to conservative treatment on clinical outcomes in adult polytrauma patients.MethodsWe searched PubMed to identify completed and ongoing studies from inception of each database to May, 2022. We included systematic reviews including RCTs comparing chest wall osteosynthesis to conservative treatment in adult polytrauma patients.ResultsWe included one RCT with 50 patients (nosteosyntheses = 25, ncontrol = 25, median age 37.4 years, 82% male). We found that surgical rib fixation makes little or no difference to in-hospital mortality compared to conservative treatment (RR 2.00, 95% CI 0.40 to 9.95; RD 80 more per 1,000, 95% CI 48 fewer to 716 more; 1 study, 50 participants, low quality of evidence). We found that surgical rib fixation makes little or no difference to the need for mechanical ventilation compared to conservative treatment (RR 0.90, 95% CI -0.66 to 1.23; RD 80 fewer per 1,000, 95% CI 272 fewer to 184 more; 1 study, 50 participants, low certainty of evidence).ConclusionThere is limited evidence regarding chest wall osteosynthesis compared to conservative treatment in polytrauma patients. One RCT shows no effect of surgical rib fixation compared to conservative treatment regarding mortality and clinical status, but a potential benefit regarding ICU length of stay.© 2025. The Author(s).

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