Better short-term efficacy of treating severe flail chest with internal fixation surgery compared with conservative treatments

Abstract

BackgroundThe objective of the study is to provide evidence for selecting the best treatment approach for severe flail chest by comparing surgical and conservative treatments.MethodsThis is a retrospective study in which 32 patients with severe flail chest were treated in the Fujian Provincial Hospital (China) between July 2007 and July 2012 with surgical internal rib fixation (n = 17) or conservative treatments (n = 15). Mechanical ventilation time, intensive care unit (ICU) stay time, pulmonary infection, antibiotic treatment duration, acute physiology and chronic health evaluation II (APACHE II) scores 7 and 14 days after trauma, rate of tracheostomy, and rate of endotracheal re-intubation were compared.ResultsOne patient died in the conservative treatment group. Better short-term outcomes were observed in the surgery group, such as total mechanical ventilation time (10.5 ± 3.7 vs. 13.7 ± 4.4 days, P = 0.03), ICU stay (15.9 ± 5.0 vs. 19.6 ± 5.0 days, P = 0.05), pulmonary infection rate (58.8 % vs. 93.3 %, P = 0.02), and APACHE II scores on the 14th day (6.5 ± 3.8 vs. 10.1 ± 4.7, P = 0.02). No difference was observed in the therapeutic time of antibiotics, rate of tracheostomy, and the rate of endotracheal re-intubation between the two groups.ConclusionsResults suggest that internal fixation surgery resulted in better outcomes in the management of severe flail chest compared with conservative treatments.

Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review

“…The most recent publication about FC management by Xu et al found a shorter duration of mechanical ventilation and ICU stay when using operative management, supporting our findings [2]. Pneumonia rate was also significantly lower in their operative management group, but tracheostomy rate did not differ between both groups in the publication by Xu et al [2]. …”

“…“Flail chest occurs when three or more adjacent ribs are fractured in at least two places, creating a chest wall segment that moves paradoxically from the chest wall [2]. ” The paradoxical movements make breathing less efficient, resulting in poor oxygenation of blood and potential asphyxia [3].…”

Surgical stabilization of traumatic flail chest is superior to conservative management

“…They found that patients in the surgical group had shorter total mechanical ventilation time, decreased ICU stay, and decreased pulmonary infection rate. 8 Conversely, Naidoo et al evaluated 293 flail chest patients and found a non-significant benefit to conservative management, however, this study suffered from some relatively significant limitations, including retrospective design and lack of case controls. 6 Additional studies by Granhed & Pazooki, Zhang et.…”

Meta-Analysis on Comparison of Therapeutic Effects of Different Treatment Methods on Multiple Rib Fractures

“…A special phenomenon called flail chest sometimes occurs when multiple rib fractures happen. Flail chest refers to the fracture of 3 or more than 3 ribs in adjacent parts at one side or two sides of the chest, leading to destruction of the thorax stability, softening of chest wall, and thus the paradoxical respiratory movement [2][3]. It often causes the lowering of respiratory efficiency of patients, then expiratory dyspnea, hypoxemia, and even respiratory distress syndrome, threatening the life of patients.…”