Potential Benefits of Rib Fracture Fixation in Patients with Flail Chest and Multiple Non-flail Rib Fractures

Abstract

The purpose of this study is to evaluate the potential benefits of rib fracture fixation in patients with flail chest and multiple non-flail rib fractures versus conventional treatment modalities. A retrospective reviewed study compared 86 cases which received surgical treatment between June 2009 and May 2013 to 76 cases which received conservative treatment between January 2006 and May 2009. The patients were divided into the flail chest (n=38) and multiple non-flail rib fracture groups (n=124). In the flail chest group, the mechanical ventilation time, ICU monitoring time, tracheostomies, thoracic deformity, and impaired pulmonary function and return to full-time employment were compared. In the multiple non-flail rib fracture group, fracture healing, visual analog scale (VAS) pain score, inpatient length of stay, atelectatic, pulmonary complications, and normal activity-returning time were compared. Patients in the flail chest operative fixation group had significantly shorter ICU stay, decreased ventilator requirements, fewer tracheostomies, less thoracic deformity and impaired pulmonary function, and more returned to fulltime employment. Patients in the multiple non-flail rib fracture operative fixation had shorter hospital stay, less pain, earlier return to normal activity, more fracture healing, less atelectasis, and fewer pulmonary infections. This study demonstrates the potential benefits of surgical stabilization of flail chest and multiple non-flail rib fractures with plate fixation. When compared with conventional conservative management, operatively managed patients demonstrated improved clinical outcomes.

Surgical versus conservative therapy for multiple rib fractures: a retrospective analysis

“…Surgery is the predominant method of treatment for severe thoracic trauma (22). For patients with associated multiple fractures of multiple ribs, the fractured ribs should be fixed to improve the respiratory and circulatory function of the patients (23,24). Several implants have been particularly designed for the fixation of fractured ribs.…”

Surgical management of multiple rib fractures/flail chest

“…A meta-analysis demonstrated that patients with painful, multiple rib fractures, that were not flail, benefit from surgical stabilisation with regards to pain, respiratory function and socio-professional disability (17). A more recent study corroborated these findings and further demonstrated shorter hospital stay (11.1% vs. 15.9%, P=0.013), fewer respiratory infections (4.6% vs. 17.0%, P=0.025), and an earlier return to work (28 vs. 42 days, P=0.028) (18). A further multicentre, randomised control trial of surgical stabilisation of rib fractures in patients with non-flail fracture patterns is ongoing (19).…”

Efficacy of nickel‑titanium memory alloy in the treatment of multiple rib fracture combined with sternal fracture

“…According to Yang et al (15), mortality rate of the flail chest is approximately 16% which is increased if the flail chest is combined with a sternal fracture (16). Industry stepping into the advanced stage, multiple rib fractures combined with sternal fractures, with a rocketing growth of incidence rate and severe damage to human health, have become the focus of modern medicine (9,17). The advancement of the new internal fixation equipment makes the operation of patients with fractures easier and safer, for example, the nickel-titanium memory alloy, with its good histocompatibility to be deformed and deployed at low temperature and to automatically restore the original shape at body temperature, is of great help for the convenience of the fixation, the shortening of the operation time, the decrease of injuries around the fracture, and the maintenance of effective blood circulation.…”

“…However, after the above conservative treatments, patients often suffer from accumulated secretions in the respiratory tract, chest pain, tachypnea, and even dyspnea aroused from too long bed rest that will increase the risk of parenchymatous pneumonia such as acute pneumonia and persistent pneumonia, and also suffer from muscular atrophy due to easily occurring incomplete transposition or complete fractures, vulnerable to complications or recurrence of disease after treatment (7,8). With the innovation of medical technology and the advanced internal fixer with better performance, the nickel-titanium memory alloy internal fixer, has high safety, stability, maneuverability and convenience, which is able to narrow the wound, is a new type of treatment device for the flail chest (9,10). So far few studies on the efficacy of the method of internal fixation by the nickel-titanium memory alloy and the method of internal fixation by the partial pressure bandage in treating the flail chest caused by multiple rib fractures combined with sternal fractures have been reported, which inspired this study to investigate the efficacy of these two methods in the treatment of patients with multiple rib fractures combined with sternal fractures and make comparison of the postoperative adverse reactions and complications between the two methods.…”