Surgical approach to flail chest: 3 clinical cases

Abstract

Introduction

Flail chest is a severe life threatening injury with mortality rates reaching up to 33%, traditionally treated with mechanical ventilation (“internal fixation”). Recently, some authors recommend a surgical approach for highly unstable flail chest. Several rib fixation techniques have been described although none are considered gold standard. Despite growing evidence of benefits for both the patient as well as the hospital, there is a general reluctance to perform rib fixation. In smaller hospitals such as the one referred to in this text, general surgeons are called to manage these patients and as such, it is a prerequisite of their training to be aware of all available treatment options, including standard and novel surgical solutions for flail chest injury.

Case description

The 3 cases involved polytrauma victims who have undergone emergency laparotomy because of abdominal injuries. Rib osteosyntheses were undertaken once the patients were haemodynamically stable. Perforated metal plates and screws were used in all cases. All patients were readily weaned off from ventilation with no post-surgical complications from the osteosynthesis and were subsequently discharged home well. All patients remain asymptomatic and no complications were registered during a 17 months (average) follow up.

Conclusion

Surgical fixation of fractured ribs is a straightforward procedure which promotes reestablishment of ventilatory dynamics. Despite several studies favouring the surgical approach to flail chest, many surgeons are still reluctant to perform this procedure. The authors present a simple and reproducible technique, with good results.