Search Results (353)

Background/Objectives: Cerebral palsy (CP) hip displacement requires longitudinal surveillance, frequently imposing significant burden on caregivers. While Multimodal Large Language Models (MLLMs) offer a potential solution to the health literacy gap, their accuracy in interpreting pediatric pelvic radiographs remains unproven. This study evaluates the effectiveness and safety of MLLMs in addressing caregiver concerns regarding CP hip management. Methods: Fifteen deidentified pediatric pelvic radiographs representing a spectrum of hip displacement severities were processed through three MLLMs: GPT-4o, Claude 3.5, and Gemini 1.5 Pro. Nine standardized caregiver prompts (n = 95 total responses per model) were utilized to simulate common clinical queries. Outcome measures included response word count, interactive characteristics, frequency of medical disclaimers, and diagnostic accuracy. Results: Quantitative analysis revealed that Claude 3.5 produced significantly shorter responses compared to other models (p < 0.01). GPT-4o demonstrated the highest safety alignment, with a 96.9% disclaimer rate, significantly exceeding Claude (60.0%) and Gemini (76.8%) (p = 0.03). Diagnostic “hallucinations” were observed, notably Claude misidentifying non-operative cases as bilateral hip replacements. While management recommendations were clinically relevant, they remained generic rather than patient-specific, failing to measure or apply migration percentage thresholds. Encouragingly, all models consistently directed users to consult an orthopaedic surgeon. Conclusions: MLLMs represent an opportunity to enhance health literacy by providing accessible management summaries and emphasizing professional consultation. However, significant radiographic hallucinations and a lack of specific, evidence-based guidance preclude their use as standalone diagnostic tools. Currently, MLLMs should be viewed as educational adjuncts requiring expert oversight in the pediatric orthopaedic care continuum. Full article

Background: Pressure injuries (PIs) are common in patients with limited mobility and may require flap reconstruction for definitive management. However, postoperative complications and PI recurrence frequently occur. Certain flap types may be more prone to poor outcomes. This study evaluated outcomes after flap reconstruction for PIs in a medically complex population. Methods: We performed a retrospective review of patients who underwent flap reconstruction for sacral, ischial, trochanteric, or lateral malleolar PIs by a single surgeon at a tertiary care center between 2015 and 2023. Patient demographics, comorbidities, neurologic status, wound characteristics, flap type, and postoperative outcomes were collected. Outcomes were analyzed at the flap level. Results: Sixty-eight patients underwent 101 flap reconstructions. Most patients were male (68%), and spinal cord injury was present in 71%. Medical comorbidity burden was high, including anemia (61%), malnutrition (42%), preoperative osteomyelitis (44%), stool exposure near the wound (49%), and near-universal urinary incontinence. Postoperative complications were common across flap types, most commonly wound dehiscence and PI recurrence. New PIs developed at non-operative sites in about 14% of reconstructions during recovery. During the eight-year follow-up period, 19 (28%) patients expired and 21% of reconstructions were complicated by recurrence at the operative site. Conclusions: Flap reconstruction remains an important treatment for advanced PIs but is associated with high complication and recurrence rates in patients with substantial comorbidities and limited mobility. These findings support careful patient selection, preoperative optimization, and multidisciplinary postoperative care focused on preventing new PIs. Full article

Osteoporotic vertebral fractures (OVFs) are the most common fragility fractures, representing a substantial burden on healthcare systems worldwide. Although up to 30% of OVFs may be clinically silent, a subset of patients experiences an unfavorable course, developing painful pseudoarthrosis/nonunion, progressive vertebral collapse, and even neurological compromise. While initial OVF management is typically nonoperative, a considerable proportion of patients ultimately require surgical intervention. However, clear and universally accepted surgical indications are lacking, rendering clinical decision-making complex and highly individualized. In this context, evaluating the spine’s ability to withstand physiological loads in the presence of potential instability is a critical step in the treatment algorithm. Nevertheless, spinal stability remains a dynamic and multifactorial concept that requires comprehensive assessment integrating both clinical and radiological parameters. This narrative review synthesizes the current state-of-the-art literature on the assessment of stability in OVFs, with particular clinical emphasis on clinical applicability. It revisits classical trauma-derived concepts and adapts them to the specific context of OVFs. We examine the respective roles of radiography, CT and MRI in evaluating fracture characteristics and spinal stability and summarize the main clinical and radiological markers. Furthermore, we distinguish between predictors of fracture progression and indirect indicators of established or evolving instability. Finally, we review current classification systems and outline general treatment considerations, focusing on how imaging findings may guide clinical decision-making in OVFs. Overall, this review provides a comprehensive framework of key imaging and clinical features that should be systematically assessed to estimate the risk of spinal instability. Full article

Introduction: Esophagectomy has traditionally been considered mandatory after neoadjuvant therapy for locally advanced esophageal cancer. However, recent evidence has challenged this paradigm and motivated interest in organ-preservation strategies with active surveillance in patients achieving clinical complete response (cCR). Methods: A literature search was performed using PubMed/MEDLINE, ScienceDirect, and Embase databases to identify relevant studies related to non-operative management (NOM) of esophageal cancer. Evidence was synthesized qualitatively with a critical focus on the biological rationale of NOM, diagnostic limitations of response-assessment, oncologic outcomes associated with surveillance strategies and the evolving role of molecular biomarkers. Results: The safety of NOM with active surveillance is tightly linked to the diagnostic accuracy of response assessment. Although structured multimodal response assessment protocols combining endoscopy, endoscopic ultrasound, and PET-CT have shown acceptable performance, residual clinically undetectable disease might persist in some patients. Evidence from the SANO trial has suggested non-inferior short-term survival outcomes of NOM compared with immediate esophagectomy in carefully selected patients with cCR after neoadjuvant chemoradiotherapy treated within specialized centers. Nevertheless, long-term oncologic outcomes remain unknown, and uncertainty persists regarding the broader applicability of this strategy outside specialized multidisciplinary settings. Emerging biomarker-driven approaches including PD-L1 expression, microsatellite instability, and circulating tumor DNA (ctDNA) may further refine response assessment and help identify patients most suitable for organ-preservation strategies. Conclusions: Active surveillance represents a promising alternative to immediate esophagectomy in selected patients with cCR after neoadjuvant therapy. However, further studies with longer follow-up and standardized surveillance protocols are still needed to safely implement this strategy outside trial settings. Full article

Background and Objectives: Severe snowfall and icing are associated with weather-related trauma presentations, especially in cities unaccustomed to prolonged winter conditions. However, the clinical characteristics of these injuries and their implications for surgical management remain incompletely understood. This study aimed to describe injury patterns, treatment approaches, and factors associated with the need for surgery among patients presenting with extremity trauma during an intense snowfall and icing episode in Diyarbakır. Materials and Methods: This single-center retrospective observational study included patients presenting to the emergency department with extremity trauma during a severe snowfall and icing period. Demographic characteristics, injury features, imaging modality, ambient temperature, anatomical localization, and treatment approaches were analyzed. Patients were categorized according to nonoperative versus operative management. Factors associated with the need for surgery were evaluated using univariable and multivariable logistic regression analyses. Receiver operating characteristic analysis was used to assess the discriminative ability of age and ambient temperature for predicting the need for surgery. Results: A total of 943 patients were included. The largest age group was 18–44 years (38.6%), and 55.9% were male. Fractures were identified in 50.7% of cases, whereas 46.7% had no fracture and 2.7% had joint dislocation. Upper-extremity injuries predominated (65.2%), with distal segment involvement observed in 55.0% of cases. Most presentations occurred on days with mean ambient temperatures ≤ 0 °C (81.5%). Overall, 82.1% of patients were managed nonoperatively, while 17.9% required surgical treatment. In multivariable analysis, increasing age and the use of computed tomography were independently associated with the need for surgery, whereas ambient temperature was not. Conclusions: Fall-related extremity injuries during severe snowfall and icing were predominantly upper-extremity and distal injuries, and most were managed nonoperatively. The need for surgery was more strongly associated with patient age and injury complexity than with ambient temperature alone. These findings describe a distinct trauma profile during short-term winter events in mild-climate cities. Full article

There is growing interest in non-operative management (NOM) for rectal cancer patients who achieve a complete response to neoadjuvant therapy. The patients’ perspectives of these approaches are limited. Here, we describe a qualitative study where we conducted semi-structured interviews with fourteen rectal cancer patients, including seven men and seven women, who were successfully treated by NOM at our center between 2020 and 2022. The responses were analyzed using the constant comparative method. Four major thematic categories emerged: impact of rectal cancer diagnosis, treatment values, decision-making factors, and the impact of NOM surveillance. Avoidance of a stoma was a major theme in both determining patient treatment values as well as ultimately driving their decision-making. Trust in the treating physician was also found to be a major theme in decision-making. While the psychological burden of surveillance did emerge as a major theme, patients who did not have recurrence were still quite satisfied with their decision to pursue NOM. Limitations of this study include selection bias, the single-center design, and the lack of patients who ultimately experienced recurrence following NOM. As NOM of rectal cancer becomes more commonplace, understanding the patients’ perspectives will ensure appropriate counseling and shared decision-making. Full article

Background: Bladder pain syndrome (BPS) is a chronic, debilitating condition defined by the International Continence Society as bladder-related pelvic pain accompanied by urinary symptoms in the absence of identifiable pathology. Its heterogeneous presentation, unclear pathophysiology, and variable treatment response make management challenging for general urologists. This review aims to provide a practical narrative review of current understanding of BPS, with particular emphasis on diagnosis, phenotyping, and non-operative management strategies relevant to the general urologist. Methods: A narrative literature review was undertaken using PubMed/MEDLINE, Embase, Google Scholar, and major international guideline documents to identify evidence relating to the diagnosis and non-operative management of BPS. Publications from January 2015 to December 2025 were reviewed, with selected landmark earlier studies included, where clinically relevant. Priority was given to guidelines, systematic reviews, randomised trials, and cohort studies. Owing to heterogeneity in study design, patient phenotypes, and reported outcomes, findings were synthesized narratively. Results: BPS represents a heterogeneous spectrum, including Hunner-lesion and non-Hunner phenotypes, with proposed mechanisms involving urothelial dysfunction, chronic inflammation, immune dysregulation, and central sensitisation. Diagnosis remains one of exclusion, relying on careful history, examination, symptom scoring, and selective investigations. Non-operative management is stepwise and multidisciplinary, combining lifestyle modification, pelvic floor therapy, oral agents and intravesical therapy. Available evidence suggests that symptom improvement is often modest but clinically meaningful in selected patients, supporting an individualized, phenotype-informed approach to care with realistic patient counselling. Conclusions: Bladder pain syndrome remains a chronic, multifaceted disorder with profound impact on quality of life, requiring clinicians to approach patients with empathy while recognising the physical, psychological, and social burden of the condition. Effective management requires early recognition, thoughtful phenotyping, exclusion of confusable conditions, and realistic expectation-setting within a multidisciplinary framework. For the general urologist, a structured and compassionate non-operative approach can improve symptom control, support shared decision-making, and help guide timely escalation when required. Full article

Background and Objectives: Pediatric liver injury is a frequent solid organ injury after blunt abdominal trauma, and its management has progressively shifted toward nonoperative care in hemodynamically stable children. This narrative review aims to synthesize current evidence regarding diagnosis, eligibility for nonoperative management, inpatient monitoring, outcomes, complications, escalation criteria, and post-discharge care in pediatric liver trauma. Materials and Methods: A structured literature search was performed in PubMed/MEDLINE, Scopus, and Web of Science, with supplementary screening through Google Scholar and reference lists. Publications from January 2000 to December 2025 were considered. The literature was analyzed descriptively and thematically, without formal risk-of-bias assessment, evidence grading, or quantitative meta-analysis. Results: The available evidence supports nonoperative management for most children with blunt liver injury who are hemodynamically stable or show a sustained response to initial resuscitation. Eligibility depends primarily on physiological status, clinical evolution, associated injuries, and institutional capability rather than imaging grade alone. Nonoperative management requires structured clinical, hemodynamic, and laboratory reassessment, with follow-up imaging reserved for selected cases based on clinical evolution or suspected complications. Delayed hemorrhage, bile leak, biloma, pseudoaneurysm, hemobilia, infection, and failure of nonoperative management remain clinically relevant and may require repeat imaging, interventional radiology, or surgery. Conclusions: Nonoperative management should be understood as an active organ-preserving strategy based on careful selection, serial reassessment, and immediate access to escalation when needed. Further pediatric liver-specific studies are required to standardize monitoring, repeat imaging, intervention thresholds, activity restriction, and post-discharge follow-up. Full article

Initial carious lesions represent a reversible stage of the caries process in which non-operative strategies can prevent lesion progression and preserve dental hard tissues. This comprehensive review provides an overview of peptide-based approaches for the management of initial carious lesions, with emphasis on self-assembling peptides. The literature was identified through PubMed electronic searches complemented by manual screening of reference lists. Only randomized clinical trials and controlled clinical studies published in English were included. The PICOS framework guided the structure of the review, focusing on patients of any age with initial carious lesions, peptide-based interventions aimed at enamel remineralization, comparisons with placebo, alternative treatments, or standard preventive care (e.g., fluoride products), and outcomes related to de-/remineralisation. Overall, the available evidence suggests that peptide-based strategies can mimic natural biomineralization and promote subsurface hydroxyapatite formation. Among the investigated approaches, the self-assembling peptide P11-4 is the most extensively studied. Evidence supports its safety and its potential to enhance initial carious lesion remineralisation, with possible advantages over fluoride alone in selected cases. In conclusion, peptide-based potentially regenerative approaches, particularly P11-4, represent a promising adjunct in minimally invasive caries management, although further long-term and comparative clinical studies are needed to define their role in routine dental practice. Full article

Background: Renal trauma is a major cause of morbidity and mortality among trauma patients, especially in low- and middle-income countries (LMICs) where penetrating injuries are common. Although international evidence increasingly supports selective non-operative management (SNOM) for haemodynamically stable patients, data from resource-limited settings remain scarce. This study sought to assess the management outcomes of patients with traumatic renal injury at a South African tertiary trauma centre, describing management patterns and outcomes and identifying predictors of in-hospital death. Methods: A retrospective audit was carried out on all consecutive trauma patients presenting with renal injuries at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) between July 2021 and June 2024. Patient demographics, injury mechanism and grade, admission physiological parameters, management strategies, complications, and outcomes were documented. Associations with in-hospital mortality were analysed using bivariate methods and Cox proportional hazards regression. Results: Of 161 patients included, 91.3% were male, with a median age of 32 years (interquartile range [IQR] 26–38). Penetrating trauma accounted for 80.1% of cases, predominantly gunshot wounds (GSWs; 49.7%). Most injuries were classified as American Association for the Surgery of Trauma (AAST) grades III–V (74.5%), and 68.3% required surgical intervention, although direct renal procedures were necessary in only 42.7% of operated patients. Nephrectomy accounted for 80.9% of renal-specific surgical interventions (38 of 47 patients who underwent a direct renal procedure). The overall in-hospital mortality rate was 17.4%. On multivariable analysis, admission lactate (hazard ratio [HR] 1.09; 95% confidence interval [CI] 1.00–1.18; p = 0.049), admission creatinine (HR 1.56; 95% CI 1.29–1.89; p < 0.001), and blood product transfusion within 24 h (HR 3.27; 95% CI 1.14–9.41; p = 0.028) were independently associated with mortality in the adjusted model. Conclusions: Admission lactate, creatinine, and early blood transfusion requirements were independently associated with in-hospital mortality in the adjusted model in this high-acuity cohort. These readily available physiological markers may facilitate early identification of high-risk patients in resource-limited settings; however, in the absence of ISS data, these variables may partly reflect the global burden of physiological insult from polytrauma rather than renal-specific predictors of death. A proportion of patients were managed non-operatively; however, given the inherent selection bias in management allocation and the absence of SNOM-specific outcome data stratified by AAST grade, no conclusions regarding the efficacy or safety of non-operative management can be drawn from this descriptive audit. Full article

Background: Thoracic paravertebral catheters are increasingly used in neonates to avoid neuraxial techniques during thoracoscopic tracheoesophageal fistula (TEF) repair. Catheter fracture and retention are exceedingly rare in this population, and optimal management remains undefined. Learning Objectives: Recognize this complication risk in neonatal paravertebral placement; identify appropriate imaging when retention is suspected; discuss conservative and surgical approaches; and understand the importance of early transparent communication with caregivers. Case: A 2-day-old term neonate weighing 2.90 kg underwent thoracoscopic repair of type C tracheoesophageal fistula with intraoperative placement of an ultrasound-guided right paravertebral catheter for continuous analgesia. The catheter was placed at the T5 vertebral level using a 20 G, 2-inch Tuohy needle with an in-plane lateral-to-medial approach. Saline hydrodissection was used to confirm entry into the paravertebral space. A 24 G radiopaque Perifix One catheter was initially inserted but proved difficult to advance. During attempted removal, some resistance was encountered, and both the needle and catheter were withdrawn together. Subsequent inspection suggested possible catheter shortening, raising concern for a retained fragment. A second catheter of size 20 G advanced via an 18 G needle was then successfully placed at the same level and was removed without complications on postoperative day 3. Comparison with an intact reference catheter revealed that the first-placed 24 G catheter was approximately 1.5 cm shorter, although the tip appeared intact. The pain physician promptly notified both the clinical teams and the family. One month later, during routine imaging for respiratory distress, a curvilinear opacity was noted at the T9 vertebral level. Dedicated thoracic spine films confirmed a 7 mm retained paravertebral catheter fragment. Multidisciplinary consensus (pain team, anesthesia, NICU, and surgery) determined that the fragment was small, non-metallic, and remote from critical structures. Conservative management with long-term follow-up was chosen. The family was informed early during initial suspicion and again upon confirmation. At 17-month follow-up, the child remained asymptomatic. Discussion: Retained catheter fragments are rare in pediatric regional anesthesia and may be radiographically occult early. In neonates, re-operation for a tiny, inert foreign body may cause more morbidity than observation. Prevention depends on appropriate equipment selection, catheter integrity checks pre- and post-placement, careful technique, and attention to resistance or difficulty during advancement or removal. Clear and timely communication with caregivers preserves trust when complications or iatrogenic uncertainty arise. Conclusions: In this neonate, a small retained paravertebral catheter fragment was identified incidentally and was safely managed with conservative observation. When such fragments are non-metallic, stable, and located away from critical structures, non-operative management with close follow-up may be an appropriate and safe approach. Full article

Background and Objectives: Small bowel obstruction (SBO) is a common surgical emergency, accounting for 15–20% of acute general surgical admissions. Despite the Bologna Guideline’s introduction to the surgical community almost a decade ago, adherence to it remains variable. The therapeutic role of contrast media and the optimal timing of its administration remain a matter of debate. This study aimed to compare SBO resolution rates according to the timing of water-soluble contrast media (WSCM) administration. Materials and Methods: A prospective, randomised pilot trial was conducted at two regional hospitals in Estonia. Patients hospitalised with adhesive or virgin abdomen SBO were randomised to receive WSCM at either 4 h or 24 h after admission. Results: A total of 128 patients were enrolled, with 63 assigned to the 4 h group and 65 to the 24 h group. SBO resolved with conservative management in 74.6% of patients in the 4 h group and 73.8% in the 24 h group. Rates of surgical intervention and bowel resection due to necrosis were comparable between groups. Univariable and multivariable analyses showed no significant association between early administration and improved resolution. A prior history of SBO was associated with a higher likelihood of successful non-operative management. Conclusions: conservative management of SBO is safe and effective, and early WSCM administration did not provide a clear additional benefit in this cohort with respect to resolution or surgical outcomes. A prior history of SBO was associated with a higher likelihood of successful conservative management in this cohort. Larger multicentre studies are warranted to further define the optimal timing of contrast administration and to compare isotonic and hyperosmolar agents with respect to clinical outcomes. Full article

Background/Objectives: Posterior C1–C2 fusion is commonly used for unstable traumatic odontoid injuries, but it is less commonly used for patients who initially undergo nonoperative management and later require salvage fusion. This study compared hospital length of stay, short-term complications, and postoperative radiographic alignment between salvage posterior C1–C2 fusion after failed nonoperative management and primary posterior C1–C2 fusion. Materials and Methods: A retrospective cohort study was performed of 106 adult patients who underwent posterior C1–C2 instrumented fusion for traumatic cervical spine injuries from 2011 to 2023. Patients were stratified into the salvage fusion group after radiographic nonunion following attempted nonoperative management with external immobilization or the primary fusion group, who underwent initial surgical management. The primary outcome was hospital length of stay. Secondary outcomes included postoperative radiographic alignment, screw loosening, hardware failure, revision surgery, and 30-day emergency department visits. Propensity score matching and full-cohort augmented inverse probability weighting were used to account for baseline differences between groups. Results: Twenty-seven patients underwent salvage fusion and 79 underwent primary fusion. Propensity score matching produced 25 matched pairs. In the matched cohort, salvage fusion was associated with significantly shorter length of stay than primary fusion, with a median of 2 versus 5 days, respectively (p < 0.001). This remained significant in the full-cohort augmented inverse probability weighting analysis, where salvage fusion was associated with a 2.41-day reduction in length of stay (95% CI, −3.63 to −1.19; p < 0.001). Short-term complications were uncommon in both groups, and no clear sign of increased screw loosening, hardware failure, revision surgery, or 30-day emergency department visits was observed in the salvage cohort. Salvage fusion was also associated with lower postoperative C2–C7 lordosis and a greater C1 lamina–occiput distance. Conclusions: Salvage posterior C1–C2 fusion for radiographic nonunion after attempted nonoperative management was not associated with higher short-term complication rates compared with primary fusion. While surgical-admission length of stay was shorter in the salvage cohort, this difference should be interpreted cautiously because salvage and primary fusion occur in different admission contexts and do not reflect the total episode-of-care burden. Early postoperative alignment differences were observed, but these were not correlated with clinical outcomes or longitudinal imaging, and their long-term significance remains unclear. Future multicenter studies should evaluate total healthcare utilization, fusion status, longitudinal alignment, and patient-reported outcomes after salvage C1–C2 fusion. Full article

Background/Objectives: Blunt suprahepatic inferior vena cava (SHIVC) injury is a rare and highly lethal condition associated with severe thoracoabdominal trauma. This study describes the clinical characteristics and outcomes of SHIVC injuries treated at a single institution. Methods: We retrospectively reviewed patients with blunt SHIVC injury treated between January 2014 and September 2023. Demographics, injury characteristics, management strategies, and outcomes were analyzed descriptively. The primary outcome was in-hospital mortality. Given the small sample size, statistical analyses were exploratory. Results: Ten patients were identified (mean age: 47 ± 17 years; mortality: 40%; ISS: 43 ± 19). On admission, 50% presented with systolic blood pressure < 90 mmHg and a mean Glasgow Coma Scale score of 7 ± 5. Non-survivors had lower systolic blood pressure (70 ± 12 vs. 115 ± 34 mmHg, p = 0.05), lower GCS scores (3 ± 0 vs. 9 ± 5, p = 0.02), and worse base excess (−20.1 ± 5.8 vs. −7.8 ± 7.1) than survivors. Surgical intervention was performed in 9 patients, while 1 was managed nonoperatively. Common associated injuries included right atrial injury (70%), liver injury (50%), and diaphragm injury (30%). Four patients received intraoperative circulatory support; two treated with cardiopulmonary bypass survived, whereas those treated with extracorporeal membrane oxygenation died. No definitive conclusions can be drawn regarding treatment effectiveness due to the limited sample size. Conclusions: Outcomes appear strongly influenced by initial physiological status and injury severity. This study is descriptive and hypothesis-generating; further multicenter studies remain warranted to define optimal management strategies. Full article

Background: Rib fractures are a common cause of morbidity in trauma patients. The surgical stabilization of rib fractures (SSRF) has gained increasing attention as a therapeutic option; however, evidence from multiple meta-analyses remains heterogeneous. Methods: We performed an overview of 11 meta-analyses, including a total of 1,117,849 adult patients (narrative umbrella review), published between November 2020 and November 2025 to summarize and critically appraise high-level evidence comparing SSRF with non-operative management (NOM) in adults with traumatic rib fractures. PubMed (MEDLINE) and Embase were searched for eligible meta-analyses. Outcomes of interest included mechanical ventilation duration, pneumonia, ICU and hospital length of stay, mortality, pain, quality of life, and need for tracheostomy. Results: Eleven meta-analyses met the inclusion criteria. Across outcomes, the direction of effect generally favored SSRF in selected patients, particularly with respect to a shorter duration of mechanical ventilation (mean difference up to approximately 4–6 days), reduced pulmonary complications (risk ratio approximately 0.4–0.7), shorter ICU and hospital stay, and improved pain control. However, results varied substantially across studies. A consistent mortality benefit was not observed. Subgroup analyses suggested that the benefits of SSRF were more pronounced in patients with flail chest, severe fracture patterns, and early surgery, whereas findings were less consistent in elderly patients and in patients with less severe injuries. Conclusions: This narrative umbrella review suggests that SSRF is associated with improved short-term outcomes in selected adult patients with traumatic rib fractures but should not be considered a universal standard of care. Careful patient selection, timing of intervention, and multidisciplinary evaluation remain essential. Further high-quality prospective studies are needed to better define optimal indications and management strategies. Full article