Surgical stabilization of flail chest: a retrospective evaluation of clinical outcomes and injury score predictive validity.

Abstract

Flail chest is a severe thoracic injury associated with high morbidity, prolonged hospitalization, and an increased risk of chronic pain. Surgical stabilization of rib fractures (SSRF) has become an increasingly accepted treatment modality in selected patients. However, the optimal timing of intervention and the prognostic value of radiologic injury scoring systems remain areas of investigation. Our findings confirm prior evidence supporting the early use of SSRF in selected patients and further explore the predictive value of radiologic injury scores in postoperative outcomes. This retrospective study included 74 patients who underwent SSRF for flail chest between 2012 and 2023. Demographic data, radiologic injury scores (AIS Thorax, RibScore, BPC18), timing of surgery, and clinical outcomes were analyzed. Patients were grouped according to age (≤ 65 vs. > 65 years) and timing of surgery (≤ 2 days vs. ≥ 3 days post-admission). Primary endpoints included ICU and hospital length of stay, postoperative complications, mortality, return to normal activity, and incidence of chronic pain. The median number of fractured ribs was 7 (IQR: 3-10), with a median AIS Thorax score of 4.05, RibScore of 4.66, and BPC18 score of 2.66. Early surgery (≤ 48 h) was associated with a significantly shorter hospital stay (median 8 vs. 10 days, p = 0.037), although ICU stay, complication rates, and return to activity did not significantly differ between early and late surgery groups. No statistically significant differences in outcomes were observed between the age groups. AIS Thorax showed the strongest correlation with ICU stay (r = 0.513, p < 0.001), followed by BPC18 (r = 0.377, p = 0.001) and RibScore (r = 0.317, p = 0.003). All three scores were significantly correlated with total hospital stay duration as well. However, none were associated with chronic pain or time to return to normal activity. Chronic pain developed in 20.2% of the patients. Logistic regression analysis revealed no independent predictors of chronic pain, including age, sex, number of fractured ribs, injury severity scores, or surgical timing. SSRF is a safe and effective treatment for flail chest, including in elderly and severely injured patients. Early surgery supports faster recovery without added complications. While injury scores reflect acute outcomes, they do not predict chronic pain or long-term recovery.