Long-Term Follow-up of Patients with Operative Stabilisation of a Flail Chest

Abstract

The outcome is reported of patients after external chest wall stabilisation for respiratory insufficiency due to a traumatic flail chest. Since 1990, all patients with a flail chest causing respiratory insufficiency despite peridural analgesia and without further reason for prolonged mechanical ventilation underwent osteosynthesis of the chest wall using the AO-technique with 3.5 mm thick reconstruction plates, and were prospectively followed-up by use of clinical and radiological evaluation. 23 patients underwent external chest wall fixation between 1990 and 1996 and were followed for a mean time of 28 months. 2 patients died after the operation, giving a 30-day-survival rate of 91.3% 21 patients survived and were extubated and transferred to the ward after a mean time interval of 3.9 and 7.8 days, respectively. 95% of the survivors revealed a 100% working capacity at assessment and 86% returned to preoperative sports activities without complaining of chest wall or shoulder girdle pain or dysfunction. External chest wall fixation appears to be an attractive alternative to prolonged intubation and mechanical ventilation for selected patients with flail-chest respiratory insufficiency despite peridural analgesia, providing they do not require prolonged intubation for other reasons.

Geometry of human ribs pertinent to orthopedic chest-wall reconstruction

“…Flail chest injury is associated with a mortality rate of 10-36% (Cacchione et al, 2000;Hellberg et al, 1981;Labitzke, 1981;Landercasper et al, 1984;Lardinois et al, 2001;SchmitNeuerburg et al, 1982). In flail chest injuries, paradoxical inward movement of the flail segment prevents effective inspiration and requires prolonged mechanical ventilation, which in turn can lead to pneumonia and sepsis (Labitzke, 1981;Lardinois et al, 2001;Mouton et al, 1997;Tanaka et al, 2002;Tscharner et al, 1989).…”

“…Early plate designs for rib fixation were straight and required intraoperative contouring (Borrely et al, 1985;Martin et al, 1982;Menard et al, 1983;Vecsei et al, 1979). Today, generic small fracture plates are most commonly used for rib fracture fixation (Engel et al, 2005;Friedrich et al, 1991;Lardinois et al, 2001;Mouton et al, 1997;Ng et al, 2001;Oyarzun et al, 1998;Reber et al, 1993). However, due to the complex geometry of ribs, intraoperative contouring of generic plates is time-consuming and difficult at best.…”

Isolated Complete Rupture of Left Main Bronchus after Blunt Chest Trauma

“…In the case of a complete rupture the bronchoscope should be used as a guide during intubation either with a double lumen tube or with a single tube [4,7,13,15]. The authors did not find any need to use either ECMO or transthoracic bronchial intubation, as mentioned in other reports [11,16].…”

“…The true incidence of tracheobronchial injury is hard to establish, as a long proportion (30 to 80%) will die before reaching the hospital [3]. Left-sided injuries occur less frequently compared to right-sided ones, probably due to the length of left mainstem bronchus [4][5][6][7][8][9][10][11][12][13] (Table 1).…”

“…Bronchoscopy is the main diagnostic procedure to confirm a bronchial disruption and should be performed in all patients with severe thoracic trauma [1,4,7,8,10,13,15]. In the case of a complete rupture the bronchoscope should be used as a guide during intubation either with a double lumen tube or with a single tube [4,7,13,15].…”