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Operative vs nonoperative treatment of acute unstable chest wall injuries. A randomized clinical trial.

Dehghan M, Nauth A, Schemitsch E, Vicente M, Jenkinson R, Kreder H et al, for the Canadian Orthopaedic Trauma Society and the Unstable Chest Wall RCT Study Investigators.

JAMA Surg 2022; 157: 983-990.

The study included 207 patients followed for up to 30 days. Ventilator-free days were higher in the operated group (22.7 versus 20.6; mean difference 2.1 days, P=0.09), and mortality was lower (0 versus 6, P=0.01). The advantage was mainly seen in patients ventilated at time of randomization. Complications rates and length of stay were similar.

Comment: Good study, but relatively modest benefit seen from surgery.

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