Open reduction and internal fixation of rib fractures in polytrauma patients with flail chest

DeFreest, Lori; Tafen, Marcel; Bhakta, Avinash; Ata, Ashar; Martone, Stephen; Glotzer, Owen; Krautsak, Kevin; Rosati, Carl; Stain, Steven C.; Bonville, Daniel J.

doi:10.1016/j.amjsurg.2015.11.014

Cited by 46 publications

(26 citation statements)

References 12 publications

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“…Three recent meta-analyses confirm these findings, and suggest a mortality benefit as well (15)(16)(17). The verdict has not been unanimous, though; at least two recent retrospective studies have failed to show a benefit to surgical stabilization in patients with flail segment (18,19). Others have demonstrated flaws in these dissenting studies, however, regarding methodology, timing of intervention, confounding injuries, and patient selection (7).…”

Section: Indications For Surgerysupporting

confidence: 55%

Blunt chest trauma: is there a place for rib stabilization?

Mitchell¹

2017

J. Thorac. Dis.

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Section: Indications For Surgerysupporting

confidence: 55%

Blunt chest trauma: is there a place for rib stabilization?

Mitchell¹

2017

J. Thorac. Dis.

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“…More and more evidence shows the benefits of surgical fixation of flail chests over non-operative management [15][16][17][18]. Although recent evidence-based guidelines advise surgical fixation in flail chest patients [19,20], the benefit of rib fixation is not unanimous and needs more comparative studies [21,22]. However surgical techniques may overcome conservative complications, it may introduce the risk of surgical side-effects.…”

Section: Introductionmentioning

confidence: 99%

Early results after operatively versus non-operatively treated flail chest: a retrospective study focusing on outcome and complications

Wijffels

Hagenaars

Latifi

et al. 2018

Eur J Trauma Emerg Surg

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Purpose Flail chest was traditionally treated non-operatively using mechanical ventilation and pain control. In order to reduce the occurrence of ventilation-associated complications and long-term disability, operative rib fixation is becoming a proven standard therapy for these patients. However, the consequences of the surgical complications may influence success rates negatively. The aim of this study was to compare the outcome of flail chest treatment by surgical rib fixation with nonoperative treatment, with special focus on the impact of surgical complications. Methods A retrospective case series of operatively treated flail chest patients was compared with non-operatively treated patients. Patients' injury and treatment characteristics and outcome parameters (e.g., duration of mechanical ventilation, length of Intensive Care stay (ICLOS) and hospital length of stay (HLOS), mortality, surgery-related complications and pneumonia) were collected from the patients' medical files. Crude and matched-pairs analyses were performed in SPSS. Results Twenty-three operatively and 47 non-operatively treated patients were enrolled. Operatively treated patients required significantly shorter mechanical ventilation; median 4 days versus 12 days for the non-operative group (p = 0.011). The matched-pairs analysis also showed a lower pneumonia rate (35% versus 80%; p = 0.035) and a shorter HLOS (median 21 versus 23 days; p = 0.028) in the operative group. No significant differences in duration of ICLOS, and occurrence of other injury-related adverse events were found between both groups. Seven surgery-related complications occurred, of which three required invasive solutions. Conclusions Operative fixation of a flail chest in trauma patients results in a lower rate of pneumonia, less mechanical ventilation days and shorter hospital stay, compared with non-operative treatment, but at the cost of surgery-related complications requiring invasive solutions in some cases.

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“…Although the trend in literature is in favor of SSRF, especially in the setting of flail chest, there is some evidence on the contrary. Defreest et al published a retrospective study including of 86 patients, 41 treated with SSRF and 45 treated conservatively [45] . Hospital length of stay and intensive care unit length of stay were significantly longer in the SSRF group.…”

Section: Implantsmentioning

confidence: 99%

Surgical Treatment of Flail Chest and Rib Fractures: A Systematic Review of the Literature

McClure

Myers

Triplet

et al. 2019

International Journal of Orthopaedics

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Rib fractures are relatively common injuries which are predominantly managed non-operatively. However, there has been an increasing amount of evidence over the past two decades supporting the role of surgical management in the presence of multiple rib fractures and flail chest. The purpose of this systematic review is to provide a comprehensive overview of the surgical management of flail chest and rib fractures along with outlining the relative indications, trends in surgical technique, and the evidence comparing operative versus non-operative treatment.

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Open reduction and internal fixation of rib fractures in polytrauma patients with flail chest

Cited by 46 publications

References 12 publications

Blunt chest trauma: is there a place for rib stabilization?

Blunt chest trauma: is there a place for rib stabilization?

Early results after operatively versus non-operatively treated flail chest: a retrospective study focusing on outcome and complications

Surgical Treatment of Flail Chest and Rib Fractures: A Systematic Review of the Literature

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