Rib fractures are one of the most common traumatic injuries and may result in significant morbidity and mortality. Despite growing evidence, technological advances and increasing acceptance, surgical stabilization of rib fractures (SSRF) remains not uniformly considered in trauma centers. Indications, contraindications, appropriate timing, surgical approaches and utilized implants are part of an ongoing debate. The present position paper, which is endorsed by the World Society of Emergency Surgery (WSES), and supported by the Chest Wall Injury Society, aims to provide a review of the literature investigating the use of SSRF in rib fracture management to develop graded position statements, providing an updated guide and reference for SSRF. This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of experts then critically revised the manuscript and discussed it in detail, to develop a consensus on the position statements. A total of 287 studies (systematic reviews, randomized clinical trial, prospective and retrospective comparative studies, case series, original articles) have been selected from an initial pool of 9928 studies. Thirty-nine graded position statements were put forward to address eight crucial aspects of SSRF: surgical indications, contraindications, optimal timing of surgery, preoperative imaging evaluation, rib fracture sites for surgical fixation, management of concurrent thoracic injuries, surgical approach, stabilization methods and material selection. This consensus document addresses the key focus questions on surgical treatment of rib fractures. The expert recommendations clarify current evidences on SSRF indications, timing, operative planning, approaches and techniques, with the aim to guide clinicians in optimizing the management of rib fractures, to improve patient outcomes and direct future research.

中文翻译：

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肋骨骨折的手术稳定 （SSRF）：WSES 和 CWIS 立场文件


肋骨骨折是最常见的创伤性损伤之一，可能导致严重的发病率和死亡率。尽管证据越来越多，技术进步和接受度越来越高，但创伤中心仍然没有统一考虑肋骨骨折的手术稳定 （SSRF）。适应症、禁忌症、适当的时机、手术方法和使用的植入物是正在进行的辩论的一部分。本立场文件得到了世界急诊外科学会 （WSES） 的认可，并得到了胸壁损伤协会的支持，旨在提供对研究 SSRF 在肋骨骨折管理中使用 SSRF 的文献的回顾，以制定分级立场声明，为 SSRF 提供更新的指南和参考。本立场文件是根据 WSES 方法制定的。指导委员会进行了文献综述并起草了立场文件。然后，一个国际专家小组对手稿进行了批判性修改并进行了详细讨论，以就立场声明达成共识。共有 287 项研究（系统评价、随机临床试验、前瞻性和回顾性比较研究、病例系列、原始文章）从最初的 9928 项研究库中选择。提出了 39 个分级立场声明，以解决 SSRF 的八个关键方面：手术适应症、禁忌症、手术最佳时机、术前影像学评估、手术固定的肋骨骨折部位、并发胸部损伤的管理、手术方法、稳定方法和材料选择。本共识文件解决了肋骨骨折手术治疗的关键重点问题。 专家建议阐明了有关 SSRF 适应症、时间、手术计划、方法和技术的当前证据，旨在指导临床医生优化肋骨骨折的管理，以改善患者预后并指导未来的研究。