• Jesse Peek, Reinier Bart Beks, Valerie Kremo, Nicole van Veelen, Alfred Leiser, Roderick Marijn Houwert, Björn-Christian Link, Matthias Knobe, Reto Hansjörg Babst, and Frank Joseph Paulus Beeres.
• Department of Orthopedic and Trauma Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland. jesse-peek@outlook.com.
• Eur J Trauma Emerg Surg. 2021 Aug 1; 47 (4): 1105-1114.

PurposeThe primary aim of this retrospective cohort study was to evaluate the pulmonary function after rib fixation for patients with multiple rib fractures and flail chest. Secondary, a systematic review was performed to give an overview of the current literature and to allow comparison with our results.MethodsAll adult (≥ 18 years) patients who underwent rib fixation for multiple rib fractures or flail chest between 2010 and 2018 and who received a control pulmonary function test during the postoperative follow-up at our level-1 trauma center were retrospectively reviewed. Secondary, the PubMed, EMBASE and Cochrane databases were searched to identify studies reporting on the pulmonary function after rib fixation. The primary outcome parameters were the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, maximum vital capacity (VCmax), total lung capacity (TLC), residual volume (RV), and RV/TC ratio.ResultsOf the 103 patients who underwent rib fixation, a total of 61 (59%) patients underwent a pulmonary function test in our hospital and were ultimately included. In the majority of patients all pulmonary function parameters fell within the normal range of the reference values. Obstructive impairment was predominantly seen in patients with pre-existing chronic obstructive pulmonary disease (COPD). Patients with multiple rib fractures had better recovery compared to those with a flail chest. The systematic review included a total of 15 studies and showed comparable results.ConclusionThe present study demonstrates that rib fixation for multiple rib fractures or flail chest results in adequate recovery of the pulmonary function within 3 months after surgery. In addition, based on the current literature, further gradual improvement to maximum pulmonary values appears to occur during the first 12 months after rib fixation.© 2019. Springer-Verlag GmbH Germany, part of Springer Nature.

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