Rib fractures are a frequent consequence of blunt chest trauma and are associated with significant morbidity and mortality, particularly in cases of flail chest or multiple displaced fractures. While conservative management remains the traditional approach, surgical stabilization of rib fractures (SSRFs) has gained increasing attention for its potential to improve outcomes. This prospective comparative cohort study, conducted between April 2018 and August 2023, compared the effectiveness of SSRF with that of nonoperative management. A total of 114 patients with respiratory compromise from unstable rib fractures were enrolled, 57 of whom underwent SSRF via custom-made titanium plates and screws (Group A) and 57 of whom received conservative treatment (Group B). Baseline demographics and associated injuries were comparable between the groups, although flail chest was more common in the surgical cohort (40.4% vs. 19.3%, p = 0.012). By discharge, patients in the SSRF group reported significantly lower pain scores (3.6 vs. 7.5, p < 0.001) and demonstrated superior pulmonary function at follow-up (FEV₁ at 3 months: 2.84 ± 0.40 L vs. 2.06 ± 0.36 L, p < 0.001). Oxygen dependence was shorter in the surgical group (2.5 ± 0.7 vs. 5.1 ± 0.8 days, p < 0.001), and fewer patients required ventilatory support (12.3% vs. 29.8%, p = 0.022). Among ventilated patients, 50% in the SSRF group were weaned within 3 days, whereas none were weaned in the conservative group (p < 0.001). The length of hospital stay was nearly halved with surgery (4.4 ± 1.5 vs. 9.4 ± 2.3 days, p < 0.001). Mortality was lower in the surgical group (5.3% vs. 15.8%), although this difference was not statistically significant (p = 0.062). Importantly, return-to-work rates at one month were markedly higher following SSRF (62.96% vs. 12.50%, p < 0.001). Compared with conservative management, SSRF offers significant benefits in terms of pain control, respiratory recovery, and functional outcomes. These findings support broader adoption of SSRF, particularly in patients with flail chest or multiple displaced rib fractures, and highlight the feasibility of custom-made implants in resource-limited settings.

Timely diagnosis and treatment delays among tuberculosis (TB) patients remain among the major challenges for controlling and eradicating the disease globally. Delayed health-seeking behavior among TB patients may either contribute to undetected and untreated TB cases or lead to poor treatment outcomes when patients are eventually diagnosed. Managing these delayed TB consultations becomes even more challenging in lower-middle-income countries (such as Pakistan), where TB incidence and transmission rates are high, but limited evidence is available on patient and health system delays in seeking and initiating TB treatment. This study aimed to assess the time delays of patients attending pharmacies managed by TB referral initiatives in Pakistan. A case detection approach utilizing a public‒private-mix (PPM) partnership was developed and fully protocolized for use; this approach involved participation in pharmacies to assess and provide a formal written referral to patients presenting with symptoms indicative of TB. Ranges of pharmacy referral implementation delay as well as diagnostic and treatment delay of TB patients were defined. Among the 500 pharmacies trained in PPM partnerships, 427 (85%) were active in providing referrals. The median pharmacy referral implementation delay was found to be 46 days. Among the 547 TB cases identified through the community pharmacy-referral network, the median diagnostic delay and treatment delay were found to be 4 days and 1 day, respectively. Time delays among TB patients diagnosed through the community pharmacy referral network in Pakistan were relatively low for diagnosis and treatment; however, delays related to the implementation of pharmacy referrals were at times longer than those reported in local, regional, and global settings.