Clinical effectiveness of complete thoracoscopy vs. thoracoscopy-assisted surgery in the treatment of multiple rib fractures in non-flail chest

Abstract

Aim: To retrospectively analyze the clinical effectiveness of complete thoracoscopy vs. thoracoscopy-assisted surgery in the treatment of multiple rib fractures in non-flail chest.

Methods: A total of 86 patients with multiple rib fractures were divided into a “Complete Thoracoscopy group” (n = 40) and a “Thoracoscopy-Assisted group” (n = 46). Perioperative clinical data, Visual Analog Scale (VAS) pain scores, and 3-month postoperative clinical effectiveness were compared between the two groups.

Results: There was no statistical difference between two groups of patients in basic information (P > 0.05). There was no significant difference between two groups in terms of number of rib fixation fractures during surgery, postoperative chest tube drainage volume, extubating time, postoperative hospital stays, as well as the incidence of common postoperative complications(P > 0.05). Compared with the Thoracoscopy-Assisted group, the Complete Thoracoscopy group had shorter incision length and longer surgical time (P < 0.05). On the 3rd and 7th day after surgery, the VAS scores of the Complete Thoracoscopy group were lower than those of the Thoracoscopy-Assisted group (P < 0.05). The clinical effectiveness of the Complete Thoracoscopy group was better than that of the Thoracoscopy-Assisted group at 3 months after surgery (P < 0.05).

Conclusions: Both complete thoracoscopy and thoracoscopy-assisted surgery have good surgical effects on multiple rib fractures. The complete thoracoscopy procedure has shorter incision length and less trauma, significantly reduces postoperative pain and improves clinical effectiveness. It is worth promoting and applying in clinical practice.

Keywords

Thoracoscopic surgery / multiple rib fractures / minimally invasive / clinical effectiveness

References

[1] Hisamune R,Nakasato K.A meta-analysis and trial sequential analysis of randomised controlled trials comparing nonoperative and operative management of chest trauma with multiple rib fractures.World J Emerg Surg2024;19:11 PMCID:PMC10949653

[2] Sawyer E,Muller N.Surgical rib fixation of multiple rib fractures and flail chest: a systematic review and meta-analysis.J Surg Res2022;276:221-34

[3] Craxford S,Marson B.Surgical management of rib fractures after blunt trauma: a systematic review and meta-analysis of randomised controlled trials.Ann R Coll Surg Engl2022;104:249-56 PMCID:PMC10334981

[4] Sermonesi G,Pieracci FM.Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper.World J Emerg Surg2024;19:33 PMCID:PMC11487890

[5] Chest Injury Research Society. Chinese consensus on diagnosis and treatment of traumatic rib and sternal fractures.Chin J Thorac Cardiovasc Surg2023;39:513-30

[6] Ali-Osman F,Sucher J.Geriatric (G60) trauma patients with severe rib fractures: is muscle sparing minimally invasive thoracotomy rib fixation safe and does it improve post-operative pulmonary function?.Am J Surg2018;216:46-51

[7] Castater C,Davis C.Video-assisted thoracoscopic internal rib fixation.Am Surg2022;88:994-6

[8] Zhang J,Ma C.Complete VATS in rib fractures: more than just a minimally invasive procedure.Ann Thorac Surg2022;114:601-2

[9] Lin ZW,Lin WK.Short-term follow-up of single-port thoracoscopic rib fracture reduction and internal fixation for the treatment of multiple rib fractures.Arch Orthop Trauma Surg2024;145:71 PMCID:PMC11663148

[10] Zhang J,Mo X.Complete video-assisted thoracoscopic surgery for rib fractures: series of 35 cases.Ann Thorac Surg2022;113:452-8

[11] Boonstra AM,Balk GA.Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain.Pain2014;155:2545-50

[12] Wang Z,Tong Y.Global, regional, and national burden of fracture of sternum and/or fracture of one or more ribs: a systematic analysis of incidence, YLDs with projections to 2030.Front Public Health2025;13:1565478 PMCID:PMC12003264

[13] Zhang Q,Ning S,Li N.Recent advances in rib fracture fixation.J Thorac Dis2019;11:S1070-7 PMCID:PMC6545518

[14] Michelitsch C,Hässig G,Furrer M.Operative stabilization of chest wall trauma: single-center report of initial management and long-term outcome.World J Surg2018;42:3918-26

[15] Franssen AJPM,Luyten JA.Treatment of traumatic rib fractures: an overview of current evidence and future perspectives.J Thorac Dis2024;16:5399-408 PMCID:PMC11388240

[16] Kelley KM,Weireter L.Early use of a chest trauma protocol in elderly patients with rib fractures improves pulmonary outcomes.Am Surg2019;85:288-91

[17] Li S,Hu P.Surgical management of multiple rib fractures in polytrauma patients: semi-damage control surgery.Int J Med Sci2024;21:2926-33 PMCID:PMC11610322

[18] Doben AR,Dudaryk R.Surgical rib fixation in traumatic rib fractures: is it warranted?.Curr Opin Anaesthesiol2022;35:172-5

[19] Daemen JHT,Geenen L.Reconsidering rib fixation: is a complete video-assisted thoracoscopic surgery approach the future for surgical stabilization?.J Thorac Dis2025;17:6348-50 PMCID:PMC12433109

[20] Huang X,Jiang X.Comparative clinical study of total thoracoscopic surgery and thoracoscopy-assisted small-incision surgery for multiple rib fractures.Sci Rep2026;16:14559 PMCID:PMC13153377

[21] Bottlang M,Noll M.Biomechanical rationale and evaluation of an implant system for rib fracture fixation.Eur J Trauma Emerg Surg2010;36:417-26 PMCID:PMC3150823

[22] Pieracci FM,Stovall RT.Completely thoracoscopic, intra-pleural reduction and fixation of severe rib fractures.Trauma Case Rep2015;1:39-43 PMCID:PMC6082437

[23] la Rosa AL, Mosiñoz-Montes R, Matehuala-García J, Román-Guzmán E, Quero-Sandoval F, Reyes-Miranda AL. [Unstable thorax fixation with bioabsorbable plates and screws. Presentation of some cases].Cir Cir2015;83:23-8

[24] Wang J,Liu Y.Clinical effect of the internal fixation for rib fracture with single utility port complete video-assisted thoracoscopic surgery.J Cardiothorac Surg2024;19:59 PMCID:PMC10840259

[25] Wang D,Wang Q,Wang X.A cohort study on the comparison of complications, short-term efficacy, and quality of life between thoracoscopic surgery and traditional surgery in the treatment of rib fractures.Contrast Media Mol Imaging2022;2022:2079098 PMCID:PMC9132641

[26] Yang Y,Zhang J.Completely thoracoscopic surgical stabilization of rib fractures: balancing minimally invasive benefits against technique-specific complications: a single-center retrospective study.World J Emerg Surg2025;20:54 PMCID:PMC12186360

[27] Qian G,He J.Outcomes of internal rib fixation through complete video-assisted thoracoscopic surgery for multiple rib fractures and flail chest in severe chest trauma.Eur J Trauma Emerg Surg2025;51:2 PMCID:PMC11717802

[28] Kayata H,Terakawa K.Feasibility and efficacy of video-assisted thoracoscopic surgery for the surgical stabilization of rib fractures: a single-center retrospective cohort study.Eur J Trauma Emerg Surg2025;51:277 PMCID:PMC12373530

[29] Wu TH,Chou YP,Huang WY.Facilitating ventilator weaning through rib fixation combined with video-assisted thoracoscopic surgery in severe blunt chest injury with acute respiratory failure.Crit Care2020;24:49 PMCID:PMC7017455

[30] Bauman ZM,Puthoff G,Gardner S.An early analysis of polyetheretherketone (PEEK) plates for the surgical stabilization of rib fractures: a pilot study.Injury2024;55:111969

[31] Fukunaga N,Wakami T.Fixation devices made of poly-L-lactide composite for rib reconstruction after thoracotomy.J Cardiothorac Surg2024;19:130 PMCID:PMC10941403

[32] Yoon DW,Cha MJ.Three-dimensional printed pure-titanium implantation for chest wall reconstruction involving the sternum and ribs: a novel approach.Interdiscip Cardiovasc Thorac Surg2024;38:ivae037 PMCID:PMC11009014