Plates versus struts versus an extracortical rib fixation in flail chest patients: Two-center experience

Divisi, Duilio; Mucilli, Felice; Leonardo, Gabriella Di; Zaccagna, Gino; Vico, Andrea De; Camplese, Pierpaolo; Angeletti, Chiara; Crisci, Roberto

doi:10.1016/j.injury.2020.09.018

Cited by 7 publications

(6 citation statements)

References 32 publications

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“…Since the entity of the CCI as a combination injury may have given the indication for operative stabilization, the improved postoperative stability in the CCI group would explain a lower mortality through potentially reduced respiratory failure during its course [7]. Similarly, recent work has shown that surgical management of FC can be a promising and beneficial therapy strategy [2,[12][13][14][15][16][17]. However, some studies were rather cautious with regard to surgical intervention of rib fractures so that the literature remains somehow controversial [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

The significance of a concomitant clavicle fracture in flail chest patients: incidence, concomitant injuries, and outcome of 12,348 polytraumata from the TraumaRegister DGU®

Bakır

Langenbach

Pinther

et al. 2021

Eur J Trauma Emerg Surg

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Purpose Isolated clavicle fractures (CF) rarely show complications, but their influence in the thorax trauma of the seriously injured still remains unclear. Some authors associate CF with a higher degree of chest injuries; therefore, the clavicle is meant to be a gatekeeper of the thorax. Methods A retrospective analysis of the TraumaRegister DGU® (project 2017-10) was carried out involving the years 2009–2016 (ISS ≥ 16, primary admission to a trauma center). Cohort formation: unilateral and bilateral flail chest injuries (FC), respectively, with and without a concomitant CF. Results 73,141 patients (26.5% female) met the inclusion criteria and 12,348 had flail chest injuries (FC; 20.0% CF; 67.7% monolateral FC), 25,425 other rib fractures (17.7% CF), and 35,368 had no rib fractures (6.5% CF). On average, monolateral FC patients were 56.0 ± 17.9 years old and bilateral FC patients were 57.7 ± 19 years old. The ISS in unilateral and bilateral FC were 29.1 ± 11.7 and 42.2 ± 12.9 points, respectively. FC with a CF occurred more frequently with bicycle and motorbike injuries in monolateral FC and pedestrians in bilateral FC injuries and less frequently due to falls. Patients with a CF in addition to a FC had longer hospital and ICU stays, underwent artificially respiration for longer periods, and died less often than patients without a CF. The effects were highly significant in bilateral FC. CF indicates more relevant concomitant injuries of the lung, scapula, and spinal column. Moreover, CF was associated with more injuries of the extremities in monolateral CF. Conclusion Due to the relevance of a concomitant CF fracture in FC, diagnostics should focus on finding CFs or rule them out. Combined costoclavicular injuries are associated with a significantly higher degree of thoracic injuries and longer hospital stays.

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Section: Discussionmentioning

confidence: 99%

The significance of a concomitant clavicle fracture in flail chest patients: incidence, concomitant injuries, and outcome of 12,348 polytraumata from the TraumaRegister DGU®

Bakır

Langenbach

Pinther

et al. 2021

Eur J Trauma Emerg Surg

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show abstract

“…Although the literature remains somehow controversial to surgical repair of rib fractures in general, we believe that there are signi cant advantages to surgical intervention, such as reduced respiratory failure (11)(12)(13)(14). Recent studies support our estimation of a bene cial operative therapy strategy, especially in analogous severe thoracic traumata as in ail chest or costoclavicular injuries (11,(15)(16)(17)(18)(19)(20)(21)(22). For other, similar injury patterns with e.g.…”

Section: Discussionmentioning

confidence: 71%

Combined Disruption Of The Thoracic Spine And Costal Arch Fracture: An Indicator Of A Severe Chest Trauma

Schulz-Drost

Kloesel

Kühling

et al. 2022

Preprint

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Background: Blunt high-energy trauma increase the risk of associated thoracic and accompanying abdominal organ injuries in chest trauma. A higher overall injury severity has been shown for sternovertebral injuries caused by a flexion-compression mechanism. Literature for a hyperextension-distraction mechanism equivalent to a costal arch fracture combined with a thoracic spinal fracture is sparse. Therefore, we want to show the clinical significance of this entity.Methods: A retrospective analysis of our level-one trauma center collective of severely injured patients was performed. Patients from 2013 to 2019 that involved an Injury Severity Score (ISS) ≥16 were screened for the combined thoracovertebral injury entity and analyzed concerning its accident mechanism, the injury spectrum, and the clinical course.Results: The thoracovertebral injury entity is rare. Three male patients (50–65 years old) with ISS of 57, 41, and 20 could be observed from over 1000 severely injured. All patients suffered from high-energy trauma and from tearing of the thoracic vertebrae regions 7–9. The costal arch was torn in the anterior area. All cases showed a posterolateral serial rib fracture, a traumatic intercostal pulmonary hernia, and an avulsion of the diaphragm. Two patients sustained further life-threatening injuries, such as severely bleeding avulsion to the azygos vein and a rupture of the spleen. The physicians performed exploratory thoracotomy, closure of the pulmonary hernia, re-fixation of the diaphragm and angle-stable plate osteosynthesis of the fractured ribs, including the costal arch. The spine was fixed dorsally using a screw-rod system. The patients were discharged home with independent mobility and without neurological damage. Conclusions: This thoracovertebral injury entity is associated with high overall injury severity and life-threatening thoracoabdominal injuries. Injuries to the costal arch can act as an indicator of severe trauma. They should be detected thorough clinical examination and assessment of the trauma CT in the soft tissue window.

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“…The main objectives of the chest wall reconstruction are the respiratory function restoration, organ protection and pain reduction. In a multicenter study (45) we found that plates, screws or struts showed the same excellent results in the surgical stabilization of flail chest. The ideal timing for intervention is within 72 hours from trauma (16,45,46), if patients showed the hemodynamic and respiratory stabilization.…”

Section: Discussionmentioning

confidence: 81%

Reconstructive options of the chest wall after trauma: a narrative review

Divisi¹,

Vico²,

Zaccagna³

et al. 2023

AME Surg J

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Background and Objective: Trauma remains the third leading cause of death in the world and the involvement of the chest with multiple rib fractures is an aggravating factor in the patient's outcomes. We perform a review of the literature, examining the current surgical options, in order to evaluate the most effective method of restoring quickly the excellent general conditions. Methods:We carried out research of the papers in literature by performing a search on the MEDLINE database through PubMed including works from the past 10 years using the following criteria: "chest trauma AND chest wall". A total of 1,385 results were obtained and 1,108 articles were identified after the duplicates were removed. Only 214 were rated relevant after reading the full text.

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Plates versus struts versus an extracortical rib fixation in flail chest patients: Two-center experience

Cited by 7 publications

References 32 publications

The significance of a concomitant clavicle fracture in flail chest patients: incidence, concomitant injuries, and outcome of 12,348 polytraumata from the TraumaRegister DGU®

The significance of a concomitant clavicle fracture in flail chest patients: incidence, concomitant injuries, and outcome of 12,348 polytraumata from the TraumaRegister DGU®

Combined Disruption Of The Thoracic Spine And Costal Arch Fracture: An Indicator Of A Severe Chest Trauma

Reconstructive options of the chest wall after trauma: a narrative review

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