Background: Late consequences after multiple rib fractures remain clinically important, especially in patients managed nonoperatively. This study aimed to compare 12-month late complications and functional outcomes between nonoperative management and surgical stabilization of rib fractures (SSRF) in patients with blunt chest trauma.

Methods: This multicenter prospective cohort included 192 eligible patients with blunt chest trauma and rib fractures treated at three Vietnamese trauma centers, comprising 64 patients treated with SSRF and 128 managed nonoperatively. Twelve-month outcomes were assessed in an extended follow-up conducted after completion of the primary study. This complete-case analysis included 155 of the 192 patients: all 64 patients (100%) in the SSRF group and 91 of 128 patients (71.1%) in the nonoperative group; all 37 losses to follow-up occurred in the nonoperative group. Treatment allocation was nonrandomized, and comparisons were unadjusted for baseline differences between groups. The primary outcome was chronic chest wall pain at 12 months. Secondary outcomes included exertional dyspnea, chest wall deformity, clinical symptoms suggestive of rib malunion/nonunion, pulmonary function, EQ-5D-5L, and return to work.

Results: In this unadjusted complete-case comparison, patients who underwent SSRF had lower rates of chronic chest wall pain (10.9% vs. 34.1%, p=0.001), exertional dyspnea (12.5% vs. 31.9%, p=0.006), chest wall deformity (3.1% vs. 16.5%, p=0.012), and clinical symptoms suggestive of rib malunion/nonunion (4.7% vs. 18.7%, p=0.015) than patients managed nonoperatively. Patients who underwent SSRF also had higher 12-month FVC (90.8±9.4% vs. 82.1±12.6% predicted, p<0.001), FEV1 (88.7±10.1% vs. 80.4±13.2% predicted, p<0.001), and EQ-5D-5L index (0.93±0.08 vs. 0.84±0.13, p<0.001). The two groups differed significantly at baseline in injury severity score, admission pain score, and frequency of flail chest and chest wall deformity.

Conclusion: In this multicenter prospective cohort, patients who underwent SSRF had more favorable observed 12-month pain, pulmonary-function, and quality-of-life outcomes than complete-case participants managed nonoperatively. However, these comparisons were unadjusted and were affected by substantial baseline imbalance and differential loss to follow-up. The findings should therefore be considered exploratory and should not be interpreted as establishing a causal treatment effect. Further studies using adjusted analyses, standardized imaging follow-up, and health-economic evaluation are warranted.