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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 4/2014

01-08-2014 | Original Article

Surgical stabilization of flail chest: the impact on postoperative pulmonary function

Authors: S. M. Said, N. Goussous, M. D. Zielinski, H. J. Schiller, B. D. Kim

Published in: European Journal of Trauma and Emergency Surgery | Issue 4/2014

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Abstract

Objectives

Flail chest results in significant morbidity. Controversies continue regarding the optimal management of flail chest. No clear guidelines exist for surgical stabilization. Our aim was to examine the association of bedside spirometry values with operative stabilization of flail chest.

Methods

IRB approval was obtained to identify patients with flail chest who underwent surgical stabilization between August 2009 and May 2011. At our institution, all rib fracture patients underwent routine measurement of their forced vital capacity (FVC) using bedside spirometry. Formal pulmonary function tests were also obtained postoperatively and at three months in patients undergoing stabilization. Both the Synthes and Acute Innovations plating systems were utilized. Data is presented as median (range) or (percentage).

Results

Twenty patients (13 male: 65 %) with median age of 60 years (30–83) had a median of four ribs (2–9) in the flail segment. The median Injury Severity Score was 17 (9–41) and the median Trauma and Injury Severity Score was 0.96 (0.04–0.99). Preoperative pneumonia was identified in four patients (20 %) and intubation was required in seven (35 %). Median time from injury to stabilization was four days (1–33). The median number of plates inserted was five (3–11). Postoperative median FVC (1.8 L, range 1.3–4 L) improved significantly as compared to preoperative median value (1 L, range 0.5–2.1 L) (p = 0.003). This improvement continued during the follow-up period at three months (0.9 L, range 0.1–3.0) (p = 0.006). There were three deaths (15 %), none of which were related to the procedure. Subsequent tracheostomy was required in three patients (15 %). The mean hospital stay and ventilator days after stabilization were nine days and three days, respectively. Mean follow-up was 5.6 ± 4.6 months.

Conclusion

Operative stabilization of flail chest improved pulmonary function compared with preoperative results. This improvement was sustained at three months follow-up.
Literature
1.
Davignon K, Kwo J, Bigatello LM. Pathophysiology and management of the flail chest. Minerva Anestesiol. 2004;70:193–9.PubMed
2.
Beg MH, Reyazuddin, Ansari MM. Conservative management of flail chest. J Indian Med Assoc. 1990;88:186–7.
3.
Gaillard M, Herne C, Mandin, Raynaud P. Mortality prognosis factors in chest injury. J Trauma. 1990;30:93–6.
4.
Campbell DB. Trauma to the chest wall, lung, and major airways. Semin Thorac Cardiovasc Surg. 1992;4:234–40.PubMed
5.
Voggenreiter G, Neudeck F, Aufmkolk M, Obertacke U, Schmit-Neuerburg KP. Operative chest wall stabilization in flail chest: outcomes of patients with or without pulmonary contusion. J Am Coll Surg. 1998;187:130–8.PubMedCrossRef
6.
7.
Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma. 2002;52(4):727–32.PubMedCrossRef
8.
Avery AE, Morch ET, Benson DW. Critically crushed chest: a new method of treatment with continuous mechanical hyperventilation to produce alkalotic apnea and internal pneumatic stabilization. J Thorac Surg. 1956;32:291–308.PubMed
9.
Chihara K, Hitomi S, Kobayashi J, Kawarasaki S. Preservation and improvement of chest wall function. Nippon Geka Gakkai Zasshi. 1991;92:1363–6.PubMed
10.
Fleming WH, Bowen JC. Early complications of long term respiratory support. J Thorac Cardiovasc Surg. 1972;64:729–38.PubMed
11.
Graeber GM, Cohen DJ, Patrick DH, et al. Rib fracture healing in experimental flail chest. J Trauma. 1985;25:903–8.PubMedCrossRef
12.
Landercasper J, Cogbill TH, Lindesmith LA. Long-term disability after flail chest injury. J Trauma. 1984;24:410–4.PubMedCrossRef
13.
Zahoor A, Zahoor M. Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation. J Thorac Cardiovasc Surg. 1995;110:1676–80.CrossRef
14.
Moore P. Operative stabilization of non-penetrating chest injuries. J Thorac Cardiovasc Surg. 1975;70:619–30.PubMed
15.
Thomas AN, Blaisdell FW, Lewis FR, Schlobohm RM. Operative stabilization for flail chest after blunt trauma. J Thorac Cardiovasc Surg. 1978;70:619–26.
16.
Crutcher RR, Nolen TM. Multiple rib fracture with instability of chest wall. J Thorac Surg. 1956;32:15–21.PubMed
17.
Bottlang M, Helzel I, Long WB, Madey S. Anatomically contoured plates for fixation of rib fractures. J Trauma. 2010;68(3):611–5.PubMedCrossRef
18.
Fitzpatrick DC, Denard PJ, Phelan D, et al. Operative stabilization of flail chest injuries: review of literature and fixation options. Eur J Trauma Emerg Surg. 2010;36(5):427–33.PubMedCentralPubMedCrossRef
19.
Granetzny A, Abd M, Emam E, et al. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact Cardiovasc Thorac Surg. 2005;4(6):583–7.PubMedCrossRef
20.
Slobogean GP, MacPherson CA, Sun T, Pelletier ME, Hameed SM. Surgical fixation vs nonoperative management of flail chest: a meta-analysis. J Am Coll Surg. 2013;216(2):302–11.PubMedCrossRef
21.
Bhatnagar A, Mayberry J, Nirula R. Rib fracture fixation for flail chest: what is the benefit? J Am Coll Surg. 2012;215(2):201–5.PubMedCrossRef
22.
Lardinois D, Krueger T, Dusmet M, et al. Pulmonary function testing after operative stabilization of the chest wall for flail chest. Eur J Cardiothorac Surg. 2001;20(3):496–501.PubMedCrossRef
Metadata
Title
Surgical stabilization of flail chest: the impact on postoperative pulmonary function
Authors
S. M. Said
N. Goussous
M. D. Zielinski
H. J. Schiller
B. D. Kim
Publication date
01-08-2014
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 4/2014
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-013-0344-9

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