Surgical stabilization of flail chest after trauma: when, why and how to do it?

Abstract

Chest trauma is the third most common injury in trauma patients and its presence in the setting of multi-systemic trauma can significantly increase patients' morbidity and mortality. In up to 15% of cases, flail chest (FC) may occur as a consequence of blunt trauma; it is defined as a pathologic condition that happens "when three or more adjacent ribs are fractured in at least two places, creating a chest wall segment that moves paradoxically from the chest wall" (1,2) (Figure 1). The fast evolution to respiratory failure and death (occurring from 10 to 36% of cases), as well as late complications like pneumonia, ARDS, atelectasis, chronic pain and deformity (3,4), make the proper management

Nuss Procedure for Surgical Stabilization of Anterior Flail Chest with Mechanical Ventilation Weaning Failure: A Case Report

“…Recent reviews have suggested proceeding with surgical stabilization when respiratory failure, intractable pain and dyspnea, or failure to wean from mechanical ventilation occurs [ 6 , 7 ]. Early surgical intervention (within 24–72 hours after the injury) has also been recommended [ 6 , 7 ]. However, the timing of surgery must be made in the context of the patient’s overall clinical condition.…”

“…However, the timing of surgery must be made in the context of the patient’s overall clinical condition. Traditional contraindications for surgery are hemodynamic instability, severe traumatic brain injury, unstable spine or pelvic fractures, and pulmonary contusion [ 6 , 7 ].…”

Surgical Stabilization of Flail Chest after Blunt Trauma

“…Both methods described so far: osteosynthesis systems and intramedullary stabilization (kischner's wire and wire stitches) were used for stabilization of the flail chest. No consensus has yet been achieved on the ideal rib fractures fixation device (7), being the choice of the surgical procedure mostly related to the surgeonsʾ expertise and technological improvements (8).…”