Surgical stabilization of rib fractures in adults without flail chest: a scoping review of pain, quality of life, and clinical outcomes

Background: Rib fractures are common after blunt thoracic trauma and cause severe pain, impaired ventilation, and pulmonary complications. Surgical stabilization of rib fractures (SSRF) is established for flail chest, but its role in non-flail patients remains uncertain, with heterogeneous patient selection, timing, and outcomes. This scoping review aimed to map the extent, nature, and gaps of the evidence on SSRF in adults with acute non-flail rib fractures, focusing on pain, quality of life, complications, and hospital resource use.

Methods: Following Joanna Briggs Institute methodology and the PRISMA extension for Scoping Reviews (PRISMA-ScR), we searched MEDLINE, Embase, Cochrane CENTRAL, LILACS, ClinicalTrials.gov, OSF Registries, and OpenGrey/Google Scholar from inception to 1 June 2026, without date or language restriction. Mixed studies were eligible only when non-flail data were separately extractable; others were treated as indirect evidence. Two reviewers independently screened, charted in duplicate, and appraised all studies.

Results: Eleven studies were included: one randomized controlled trial (SOFRIB, n=236), one hybrid randomized/preference trial (NONFLAIL, n=110), eight cohort studies, and one single-arm series. NONFLAIL showed significantly lower pain scores with surgery at 2, 4, and 8 weeks; other studies showed a time-dependent pattern: worse pain immediately postoperatively but better pain at discharge or follow-up. Validated quality of life and pain-impact instruments were used in a minority of studies, with mixed results. Length of stay was generally longer with surgery. In SOFRIB, intensive-care-unit stay did not differ (P=0.17), whereas hospital stay was longer (+3.3 days) and pneumonia more frequent (11.4% vs. 3.3%) with surgery, alongside gains in general-health and pain-impact scores (all P<0.05).

Conclusions: The evidence is limited, heterogeneous, and dominated by observational designs, complemented by one controlled and one randomized trial. The most consistent signal concerns follow-up pain, whereas in-hospital resource use is unfavorable and quality of life mixed; these directions reflect consistency rather than established benefit. Adequately powered randomized trials using validated, time-resolved outcomes remain needed.