Chest wall stabilization in trauma patients: why, when, and how?

Abstract

Blunt trauma to the chest wall and rib fractures are remarkably frequent and are the basis of considerable morbidity and possible mortality. Surgical remedies for highly displaced rib fractures, especially in cases of flail chest, have been undertaken intermittently for more than 50 years. Rib-specific plating systems have started to be used in the last 10 years. These have ushered in the modern era of rib repair with chest wall stabilization (CWS) techniques that are safer, easier to perform, and more efficient. Recent consensus statements have sought to define the indications and contraindications, as well as the when, the how, and the technical details of CWS. Repair should be considered for patients who have three or more displaced rib fractures or a flail chest, whether or not mechanical ventilation is required. Additional candidates include patients who fail non-operative management irrespective of fracture pattern and those with rib fractures who need thoracic procedures for other reasons. Traditionally, unstable spine fracture and severe traumatic brain injury are definite contraindications. Pulmonary contusion's role in the decision to perform CWS remains controversial. A range of rib-specific plating systems are now commercially available.

Minimally invasive chest wall stabilization: a novel surgical approach to video-assisted rib plating (VARP)

“…It was not until the mid-2000 that the technological advancement with the operative systems to make the procedure safe. There are many devices that can be used for plating, including unicortical of bicortical fixation systems 2. These authors used a second-generation, U-plate Acute Innovations RibLoc system which allows for purchase on the front and back of the fractured rib.…”

“…Chest wall trauma is a source of significant morbidity and mortality 1 2. The rate of complications for chest trauma increases with age, number of rib fractures, and displaced or flail segments 3–5.…”

Facilitating ventilator weaning through rib fixation combined with video-assisted thoracoscopic surgery in severe blunt chest injury with acute respiratory failure

“…ARF is a dangerous posttraumatic complication that occurs mainly when both chest wall and lung parenchyma are destroyed in severe blunt chest injuries [20]. This emergency situation requires rapid resuscitation through the immediate insertion of an endotracheal tube with ventilator support.…”

Current Situation of Surgical Treatment for Rib Fractures in China: Questionnaires from Multi-hospital

“…It is generally accepted that CWS for ribs 1and 2 and paraspinal rib fractures and costal cartilage fractures is not necessary since they are very di cult to expose while contributes little to respiratory physiology [9]. Likewise, CWS for ribs 11and 12 and dislocation of sternoclavicular joinis is also not suggested for the same reasons.…”