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Thoracoscopic fixation reduces postoperative pain and blood loss in patients with multiple rib fracturesThoracoscopic surgery may reduce pain for patients with rib fractures

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Key Takeaway
Note that thoracoscopic fixation may reduce postoperative pain and blood loss in rib fracture repairs.

This meta-analysis evaluated the effectiveness and safety of thoracoscopic fixation versus open fixation for patients with multiple rib fractures across 9 studies involving 751 patients. The analysis indicates that thoracoscopic fixation is associated with significantly lower postoperative pain on day 1 (SMD = -1.12, 95% CI -1.64 to -0.61) and day 7 (SMD = -1.90, 95% CI -3.08 to -0.73). Additionally, thoracoscopic fixation resulted in shorter incision lengths (MD = -4.19 cm), less blood loss (MD = -18.56 mL), and a reduction in pleural effusion frequency (OR 0.32, 95% CI 0.10-1.00).

Regarding surgical efficiency, no significant difference was found in operative time (MD = 9.66 min). Patients undergoing thoracoscopic fixation also experienced shorter hospital stays (MD = -2.05 days).

The authors note that the evidence is limited by significant heterogeneity and a predominance of observational studies. Because of these factors, the certainty of the results is not reported, and more rigorous prospective trials are needed to confirm these findings for clinical practice.

Dealing with multiple broken ribs is incredibly painful, often making it hard to breathe deeply or rest comfortably. Doctors have long used two main ways to stabilize these bones: open fixation and thoracoscopic fixation, which uses a smaller scope. New data comparing these methods suggests that the less invasive approach offers several benefits for patients.

By looking at 751 patients, researchers found that those who had thoracoscopic surgery reported significantly lower pain on day one and day seven after their procedure. These patients also had smaller incisions, lost less blood during surgery, and spent fewer days in the hospital. While the time it took to perform the operation was about the same for both methods, the thoracoscopic group saw fewer cases of pleural effusion, which is a buildup of fluid around the lungs.

It is important to note that these findings come from a mix of study types, including several observational studies. Because of this variety and some inconsistencies in the data, researchers say we still need more rigorous trials to be certain of the results. Talk with your doctor about which surgical method is best for your specific injury.

What this means for you:
Thoracoscopic surgery may offer less pain, smaller incisions, and shorter hospital stays for rib fracture patients.

Common questions

How does thoracoscopic surgery compare to open surgery for rib fractures?

Thoracoscopic fixation is associated with several benefits over open fixation. Patients had less pain on day one and day seven, smaller incisions (about 4.19 cm shorter), and lost about 18.56 mL less blood during the procedure.

Will I have to stay in the hospital longer if I have rib fractures?

Patients who underwent thoracoscopic fixation stayed in the hospital for an average of 2.05 fewer days compared to those who had open surgery. This suggests a faster recovery period for many patients.

Are there any risks or side effects involved with these surgical methods?

The study found that pleural effusion, which is a buildup of fluid around the lungs, was less frequent in patients who had thoracoscopic fixation. However, because the data includes observational studies, more research is needed to confirm all safety outcomes.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
BACKGROUND: Multiple rib fractures cause substantial morbidity through severe pain, impaired ventilation, and pulmonary complications. While open rib fixation is well established, thoracoscopic fixation may reduce soft-tissue trauma and enhance recovery, but comparative evidence remains unclear. This systematic review and meta-analysis aimed to compare thoracoscopic versus open fixation for multiple rib fractures in terms of effectiveness and safety outcomes. METHODS: We conducted a systematic literature search across PubMed, Scopus and Web of Science to retrieve comparative studies comparing thoracoscopic fixation versus traditional open fixation for multiple rib fractures regarding pain, perioperative outcomes and safety outcomes. Risk of bias of included studies was assessed using the ROBINS-I tool. A meta-analysis was conducted using a random-effects model in R (version 4.5.0). RESULTS: Nine comparative studies were identified (total participants = 751). Meta-analysis revealed that thoracoscopic fixation was associated with improved postoperative pain compared with open fixation. Pain was significantly lower with thoracoscopy on postoperative day (POD) 1 (SMD= -1.12, 95% CI -1.64 to -0.61) and POD7 (SMD= -1.90, 95% CI -3.08 to -0.73), while POD3 was not significant (SMD= -1.49, 95% CI -3.52-0.54). Thoracoscopy reduced incision length (MD= -4.19 cm) and blood loss (MD= -18.56 mL) and shortened hospital stay (MD= -2.05 days), with no difference in operative time (MD= 9.66 min). Pleural effusion was less frequent (OR 0.32, 95% CI 0.10-1.00) on thoracoscopic fixation. CONCLUSION: There may be clinically significant benefits of thoracoscopic rib fixation over open fixation for multiple rib fractures. These benefits may include less early postoperative pain, smaller incisions, less blood loss, shorter hospital stays, and no increase in operative time. Overall complication rates were similar, but thoracoscopic fixation was associated with fewer pleural effusions. Due to significant heterogeneity and the predominance of observational studies, there is a need for more rigorous prospective trials.
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