An original technique for surgical stabilisation of traumatic flail chest.

Treatment of Chest Wall Implosion Injuries Without Thoracotomy: Technique and Clinical Outcomes

“…1,2,4 -6 Several authors have reported experience with repair of flail chest injuries using a variety of methods including plates, cables, fixators, and intramedullary nails through a thoracotomy approach. [7][8][9][10][11][12][13]15,16,18,19 Significant decreases in ICU LOS, ventilatory requirements, and in-hospital infection rates with rib reduction and stabilization have been documented. 4,8,11,13,15,16,18,19 Classic anterior flail chest injuries are less common with improved secondary automotive restraints, whereas lateral compression thoracic cage injuries from side impact mechanisms are more common in trauma patients.…”

“…[7][8][9][10][11][12][13]15,16,18,19 Significant decreases in ICU LOS, ventilatory requirements, and in-hospital infection rates with rib reduction and stabilization have been documented. 4,8,11,13,15,16,18,19 Classic anterior flail chest injuries are less common with improved secondary automotive restraints, whereas lateral compression thoracic cage injuries from side impact mechanisms are more common in trauma patients. 20 -26 Aside from a flail rib segment, indications for repair of multiple rib fractures include severe displacement and overriding rib fractures, 3,8,14,16 pleural cavity volume decrease of more than 30%, 3,7,16 and pulmonary instability preventing ventilator weaning.…”

“…3,[7][8][9][10][11][12][13][14]16,18,19 The advantages of this approach include the ability to access the pleural space and lung parenchyma; however, exposure is limited in the posterior thorax and long-term shoulder impairment using this approach has been reported. 7,13,16,18 In our series, rib displacement was most pronounced in the posterior paramidline area; an area relatively inaccessible using a thoracotomy approach. The use of a paramidline posterior approach allowed access to the displaced rib segments below the second rib while iatrogenic trauma to the periscapular stabilizers was minimized by the surgical technique.…”

Historic overview of treatment techniques for rib fractures and flail chest

“…Beltrami et al and Guernelli et al [ 3 , 20 ] describe a technique in which the flail chest is stabilized by inserting two long K wires under the flail chest after an open thoracotomy.…”

“…In 1991, Landreneau et al [ 31 ] described a technique in which they refer to Beltrami et al [ 3 ]. They treat flail segments with metal struts from the Lunque ® rod orthopedic external fixation device.…”