AIM: This study aims to compare the effects of complete video-assisted thoracoscopic surgery (VATS) rib fracture (RF) fixation with a conventional open procedure on surgical parameters, inflammatory markers, and postoperative discomfort.

METHODS: This multicenter retrospective cohort study enrolled 141 patients with rib fractures, treated at The First People’s Hospital of Zunyi, Renhuai People’s Hospital, and Sinan People’s Hospital between May 2020 and December 2024. Based on the actual procedure performed, as documented in medical charts and operative records, patients were categorized into the VATS group (fully thoracoscopic internal fixation via uniportal or biportal VATS; n = 70) and the open thoracotomy group (open reduction and internal fixation; n = 71). Perioperative variables, complications, and inflammatory biomarkers (white blood cell (WBC) count, neutrophil percentage (NEU%), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6)) were compared between groups across postoperative 24 h, 72 h, and pre-discharge time points. Furthermore, follow-up outcomes, including implant-related foreign-body sensation and functional status (rib fracture functional scale (RFFS)), were also recorded. Repeated-measures analysis of variance (ANOVA) was used to evaluate time effects and time-by-group interactions, and multivariable logistic regression was performed to identify factors independently associated with an RFFS score ≥80.

RESULTS: In both groups, WBC, NEU%, CRP, PCT, and IL-6 peaked at 24 h postoperatively, declined from 72 h onward. Repeated measures ANOVA showed a significant effect of time for all markers (all p < 0.001). Compared with the open thoracotomy group, the VATS group had consistently lower WBC, CRP, PCT, and IL-6 levels at 24 h, 72 h, and before discharge, with significant time × group interaction effects for CRP and IL-6 (both p < 0.001), indicating a reduced inflammatory burden under a similar overall downward trend. NEU% changed significantly over time but showed no significant between-group or interaction effects (p > 0.05). The incidence of abnormal WBC was high in both groups at 24 h but decreased more rapidly in the VATS group. At 72 h, the proportion of patients with abnormal WBC was significantly lower in the VATS group than in the open thoracotomy group (p = 0.001), whereas more patients in the VATS group achieved normal WBC levels by discharge. No patient in the VATS group required implant removal, whereas 2.94% of patients in the open surgery group underwent implant removal due to pronounced foreign-body sensation. Postoperative hemoglobin levels were higher and electrolyte disturbances less frequent in the VATS group (both p < 0.05). Multivariable logistic regression showed that VATS (vs open thoracotomy) remained independently associated with achieving a rib fracture functional scale (RFFS) score ≥80 (p = 0.027). In addition, abnormal WBC status at 24 hours postoperatively showed a borderline association with an RFFS ≥80 (p = 0.049).

CONCLUSIONS: Complete thoracoscopic rib fracture fixation significantly reduces surgical trauma, improves recovery, and lowers the incidence of postoperative complications.