Chest wall stabilization (CWS) in China: current situation and prospect

Rib fracture is the most common injury in chest trauma. Chest wall stabilization (CWS) has been employed in China for 10 years and has been recognized as a safe and practical technique for rib fracture therapy. A survey entitled "Surgical Treatment for Rib Fractures" was launched at the beginning of 2018 showing that 95.6% of the hospitals surveyed performed CWS in over 30,000 cases in the past 2 years. Despite the large volume of CWS performed in China, we discovered the following characteristics: lack of large-scale clinical research, and standardized recognition of surgical indications, high costs incurred for surgical consumables, and undefined professional standard. We revealed that most of the researches on CWS in China have room for improvement. The Shanghai Sixth People's Hospital has conducted a series of CWS researches in patients with multi-rib fractures whose results showed shorter therapeutic time, pain reduction, lower morbidity, and improvement in lung function. Consequently, we formulated our own surgical indications for CWS. Thoracoscopic-assisted minimally invasive CWS surgery had been conducted in several hospitals in China. Undoubtedly, the continuous improvement of equipment and surgical techniques will inevitably lead to its further development. Researches on materials with superior absorbability or tissue compatibility have been successfully conducted in China. However, the lack of multi-center and large-sample randomized controlled trials has been one of the key factors that hampered the accurate evaluation of CWS. Accordingly, a nationwide study entitled "Evaluation of the effectiveness of surgical fixation of multiple rib fractures-a multi-center and ambispective cohort study" was initiated in June 2018. It is believed that the result of this research would considerably improve and enrich the clinical evidence on CWS in rib fracture patients.