Clinical Outcomes of Surgical Stabilization of Flail Chest Injury.

INTRODUCTION: Recent reported success in surgical stabilization of flail chest has been described in small series, but scant evidence exists for this procedure in the orthopaedic literature. METHODS: We reviewed 88 consecutive patients who underwent surgical stabilization of flail chest, along with 88 consecutive patients with flail chest who underwent traditional closed management before initiation of our algorithm change to surgical management. RESULTS: Surgical stabilization of flail chest injuries led to statistically significant decreases in hospital length of stay, ventilator-dependency time, pneumonia, tracheostomy, and mortality rate. In addition, the presence of pulmonary contusion did not eliminate the significant improvements in the aforementioned variables. DISCUSSION: Surgical stabilization of flail chest with modern techniques and implants provides significant improvements in both mortality and short-term outcomes. Although pulmonary contusion decreased overall outcomes across both cohorts, this factor did not alter the ability of rib fixation to improve outcomes.

Utility of three-dimensional computed tomography for the surgical management of rib fractures.

BACKGROUND: Surgical stabilization of flail chest is increasingly recognized as a valid approach to improve pulmonary mechanics in selected trauma patients. The use of two-dimensional (2D) computed tomography (CT) has become almost universal in the assessment of blunt chest trauma and multiple rib fractures. We hypothesized that three-dimensional (3D) CT adds valuable information to the preoperative plan for fixation of rib fractures. METHODS: Using a retrospective cohort of 35 consecutive adult patients with flail chest requiring surgery, we evaluated the intraobserver and interobserver reliability of plain radiographs, 2D CT and 3D CT, for the identification of rib fractures and identified how often the surgical plan changed with the addition of the information provided by the 3D CT. Two fellowship-trained orthopedic trauma surgeons who regularly operate on rib fractures in their clinical practice and were not involved in the treatment of the study population evaluated the radiographic data. RESULTS: Intraobserver and interobserver reliability was excellent for both 2D CT and 3D CT and was the highest for 2D CT. Overall, 2D CT had the highest diagnostic accuracy for detecting rib fractures as compared with plain radiographs and 3D CT. However, 3D CT changed the surgical tactic in 65.7% of the cases. CONCLUSION: We conclude that 3D CT is not as accurate as 2D CT for rib fracture diagnostic purposes; it seems to be an important tool for the preoperative planning of rib fracture fixation. LEVEL OF EVIDENCE: Diagnostic study, level II.