Flail Chest in Polytraumatized Patients: Surgical Fixation Using Stracos Reduces Ventilator Time and Hospital Stay

Abstract

Objectives. Conservative management of patients with flail chest is the treatment of choice. Rib fracture repair is technically challenging; however, with the advent of specially designed molding titanium clips, surgical management has been simplified. Surgical stabilization has been used with good outcomes. We are reporting on our institutional matched-case-control study. Methods. Between April 2010 and April 2011, ten polytraumatized patients undergoing rib stabilization for flail chest were matched 1 : 1 to 10 control patients by age ±10 years, sex, neurological or vertebral trauma, abdominal injury, and arm and leg fractures. Surgery was realized in the first 48 hours. Results. There were no significant differences between groups for matched data and prognostic scores: injury severity score, revised trauma score, and trauma injury severity score. Ventilator time (142 ± 224 versus 74 ± 125 hours, P = 0.026) and overall hospital stay (142 ± 224 versus 74 ± 125 hours, P = 0.026) were significantly lower for the surgical group after adjustment on prognostic scores. There was a trend towards shorter ICU stay for operative patients (12.3 ± 8.5 versus 9.0 ± 4.3 days, P = 0.076). Conclusions. Rib fixation with Stracos is feasible and decreases the length of ventilation and hospital stay. A multicenter randomized study is warranted so as to confirm these results and to evaluate impact on pulmonary function status, pain, and quality of life.

Risk factors for prolonged mechanical ventilation in patients with severe multiple injuries and blunt chest trauma: a single center retrospective case–control study

“…Despite progress in intensive care for severe trauma, blunt chest trauma frequently requires some ventilatory assist and is associated with significant mortality and morbidity 3, 4, 5, 6, 7…”

Crossed Kirschner’s wires for the treatment of anterior flail chest: an extracortical rib fixation

“…The experiences by Judet (22) and by Sanches-Lloret et al (23) are just historical notes. The modern evolution of cortical fixation for fractured ribs has led to the development of anatomically shaped plates -U-plate (24), ana- tomical rib plates (3,25,26). Nowadays, these latters can also be fixed via a minimally invasive technique (minimally invasive plate osteosynthesis or MIPO) (27).…”

“…Flail chest is a severe chest injury with high mortality rates. In recent reports, it accounts for 9.1% (2) of thoracic traumas with a mortality rate of 20%-33% (3,4). Patients with severe chest injury can develop not only early dramatic consequences, but also long-term effects and disability.…”

Microsurgical Reconstruction of Large Oncologic Chest Wall Defects for Locally Advanced Breast Cancer or Osteoradionecrosis: A Retrospective Review of 26 Cases over a 5-Year Period

“…The titanium struts conformed to the natural curvature of ribs and simulated the mechanical flexibility of a rib to accommodate the movements of the chest wall during ventilation, a technique used in cases where more than three ribs were excised to restore mechanical integrity and minimize the risk of a flail segment. This is an approach advocated in many series, with a range of improved outcomes: fixation is associated with fewer postoperative pulmonary infections 3,4 ; there is less time needed for postoperative mechanical ventilation [5][6][7] ; lower hospital stay 5 ; there may be a lower overall mortality 6 ; and costs are low. 6 Titanium struts are associated with reduced risk of infection compared with the common method of using a Marlex mesh sandwich with methylmethacrylate cement.…”