Abstract
Background Flail chest injuries cause significant morbidity,
especially in multiply injured patients. Standard
treatment is typically focused on the underlying lung injury
and involves pain control and positive pressure ventilation.
Several studies suggest improved short- and long-term
outcomes following operative stabilization of the flail
segments. Despite these studies, flail chest fixation remains
a largely underutilized procedure.
Methods This article reviews the relevant literature concerning
flail chest fixation and describes the different
implants and techniques available for fixation. Additionally,
an illustrative case example is provided for description
of the surgical approach.
Results Two prospective randomized studies, five comparative
studies, and a number of case series documented
benefits of operative treatment of flail chest injuries,
including a decreased in ventilation duration, ICU stay,
rates of pneumonia, mortality, residual chest wall deformity,
and total cost of care. Historically, rib fractures have
been stabilized with external plates or intramedullary
implants. The use of contemporary, anatomically contoured
rib plates reduced the need for intraoperative plate
bending. Intramedullary rib splints allowed less-invasive
fixation of posterior fractures where access for plating was
limited.
Conclusion Operative treatment can provide substantial
benefits to patients with flail chest injuries and respiratory
compromise requiring mechanical ventilation. The use of
anatomically contoured rib plates and intramedullary
splints greatly simplifies the procedure of flail chest
fixation.
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http://www.springerlink.com/content/551jj56462246473/fulltext.html
