Initial experience of intrathoracic rib fixation using RibFix AdvantageTM at a major trauma centre: operative technique and case series

Multiple rib fractures are the most frequently encountered traumatic chest injury. Randomised control trials have shown superiority of surgical stabilisation of rib fractures (SSRF) for reduction of displaced fractures in comparison to non-operative management. As SSRF techniques continue to evolve, new technologies have enabled less invasive approaches, including intrathoracic rib fixation, which can achieve chest wall stability while allowing for a less invasive approach. This article reports our initial experience with intrathoracic SSRF (I-SSRF), our operative technique, case series description, and learning points when implementing this technique. We present our operative technique alongside a single-centre, prospective case series, representing the first reported European experience with intrathoracic SSRF using the RibFix Advantage™ system. This includes the first fifteen patients with multiple rib fractures who were treated with SSRF using an intrathoracic fixation system from May 2025 to August 2025 at our major trauma centre in the United Kingdom. The majority of these patients sustained associated intrathoracic injuries requiring intervention, including haemothorax, lung lacerations, and 20% with diaphragmatic defects. The average length of stay for patients subjected to I-SSRF was 5 days (range, 3-9 days). The only reported complication was with one patient treated for wound infection with antibiotics. This early experience has highlighted a safe and effective implementation of this technique at a major trauma centre. This technique of I-SSRF in chest trauma offers benefits such as thoracoscopic assessment and repair of other intrathoracic injuries, less invasive incisions for access, and a short length of hospital stay with good pain relief for patients.