The Operative Management of Flail Chest Injuries with Concomitant Sternal Fracture

Abstract

RezumatDate generale: Leziunile de volet costal (FCI) sunt unele dintre cele mai grave leziuni toracice. Mai mult decât atât, o fractură de stern suplimentară (SF) chiar agravează rezultatele, cum ar fi durata ventilaţiei mecanice, prin urmare o fixare chirurgicală a fracturilor poate fi luată în considerare în anumite cazuri pentru a grăbi deconectarea ventilatorului. Această lucrare urmăreşte să sublinieze managementul diferitelor tipuri de SF în FCI. Metode: Toate cazurile tratate chirurgical (2012)(2013)(2014)(2015)(2016) Original ArticleCuvinte cheie: volet costal, fractură de stern, fractură sternală, fractură costală, osteosinteză cu placă blocată, Matrix Rib Abstract Background: Flail Chest Injuries (FCI) are one of the most severe thoracic injuries. Moreover, an additional sternal fracture (SF) even worsens the outcome, such as the duration of mechanical ventilation, therefore an surgical fixation of the fractures could be considered in certain cases to improve the weaning from the ventilator. This paper aims to emphasize on the management of different types of SF in FCI. Methods: All surgically treated cases (2012)(2013)(2014)(2015)(2016) that showed the combination of FCI and SF have been evaluated for their clinical details, the morphology of the fractures and the technical aspects of the surgical procedure in a retrospective investigation.Results: All of the SF (n=15) had been fixed by locked plate osteosynthesis through a median approach in a supine position. Three main regions of the sternum showed the need for different fixation strategies: the upper manubrium, central and lower corpus sterni. Concomitant rib fractures were addressed either through the same approach or through additional limited incisions. Conclusions: Combinations of SF and FCI are high risc injuries with high demand on surgical skills. They can be properly fixed with a locking plate osteosynthesis through a combination of limited incisions employing different types of plates depending on the type of SF.

Successful surgical treatment of Cronkhite-Canada Syndrome with bilateral flail chest: a case report

“…Numerous surgical methods for rib fractures have been described in the literature [22,23]. In our case, we used titanium alloy fixators and a nickel-titanium memory alloy embracing fixators.…”

Surgical reconstruction of traumatic flail chest with titanium plaques

“…The most frequent treatment modality for flail chest is mechanic ventilation today [ [4] , [5] , [6] , [7] , [8] ]. However, in the literature, it's reported that surgical rib stabilization demonstrated coherent results compared to conservative management, regarding duration of mechanical ventilation, duration of hospitalization in intensive care unit and total duration of hospitalization, incidence of pneumonia, and need for tracheostomy in flail chest patients [ 1 ].…”

“…In addition to locked plates, other osteosynthesis materials like rib clamp systems can be used or an internal bracing of the chest wall can also be performed by the way of bars [ 8 ]. However, clemp systems have significant risk of implant failure and bars have the risk of sternum fracture [ 8 ]. In our case we used titanium plaques.…”

“…In our case we used titanium plaques. Locked plate osteosynthesis has evolved to the most widespread and safest method for the surgical therapy of sternum and rib fractures [ 8 ].…”

“…In flail chest, with mediastinal flutter related to the paradoxical movement of the chest wall, related to the pressure on SVC and IVC, hemodynamics can be disturbed and the patient can undergo cardiac arrest [ 6 ]. Although in most of the cases of chest wall traumas surgical reconstruction is not needed [ [4] , [5] , [6] , [7] , [8] ], surgical stabilization was shown to be useful in certain subgroup of patients [ 5 ]. Specific guidelines are deficient for the management of certain combinations of chest wall injuries, because of their low incidence.…”