Granetzny 2005.

Methods	Study design: RCT Multicenter Setting: Cairo University and Zagazig Clinics, Cairo, Egypt Study period: not reported Sample size: not reported Follow‐up: 2 months
Participants	40 participants Sex: 31 males Age (mean ± SD): surgical group: 40.5 ± 8.2 years, clinical group: 36 ± 14.9 years Inclusion criteria: all participants with flail chest with ≥ 3 fractures of ribs and paradoxical breathing Exclusion criteria: head trauma with disturbed conscious level; associated injuries such as myocardial contusion that might be adversely affected by general anesthesia; severe associated trauma to other systems; fractures of the upper 3 ribs only, as immobilizing bandages are inefficient in fractures of the upper ribs for anatomic reasons
Interventions	Group I: conservative treatment using strapping and packing in the form of dressing and fixing with an adhesive bandage, which was put adhesively to the flail segment within 5 cm anterior and posterior to the flail segment and 1 rib above and below it. This adhesive plaster was put in place for at least 7‐10 days, during this period of follow‐up ABGs and chest X‐rays were obtained. Group II: surgical fixation of fractured ribs with stainless steel wire or Kirschner wires, or both after 24‐36 hours of ICU admission. Until the participants were operated upon, they were treated conservatively as if they were in Group I
Outcomes	Thoracic deformity, lung function, mortality, incidence of pneumonia, duration of mechanical ventilation, length of hospital stay, length of ICU stay, pleural empyema, pulmonary embolism, mediastinitis, scoliosis, and wound infection
Notes	We contacted the main author to request additional information on methodological aspects of the trial and further statistical data. The author of the study replied providing us only with the statistical data
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "random numbers balanced in blocks of 10"
Allocation concealment (selection bias)	Unclear risk	Not reported
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Not reported
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not reported
Incomplete outcome data (attrition bias) All outcomes	Low risk	There were no withdrawals
Selective reporting (reporting bias)	Low risk	No evidence
Other bias	Low risk	No evidence