Top

Journal of Cardiothoracic Surgery

Published in:

Open Access 01-12-2015 | Research article

Management of patients with flail chest by surgical fixation using claw-type titanium plate

Authors: Xufeng Zhang, Zhiqiang Guo, Chuncheng Zhao, Chenyuan Xu, Zheng Wang

Published in: Journal of Cardiothoracic Surgery | Issue 1/2015

Abstract

Background

The goal of the study was to compare surgical rib fixation using claw-type titanium plate with conservative treatment in the management of patients with flail chest.

Methods

The study retrospectively studied 23 patients suffering from flail chest injury, who admitted to our hospital from October, 2010 to February, 2014. The patients received surgical fixation by using claw-type titanium plate (surgical fixation group). A age and sex-matched cohort of 29 patients received conservative treatment and defined as conservative treatment group. Outcome variables included number of cases undergoing mechanical ventilation, ventilation time, time of hospital stay, incidence of respiratory complications, incidence of thoracic deformity and postoperative forced expiratory volume in the first second (FEV1).

Results

Compared with conservative treatment group, surgical fixation group had fewer cases undergoing mechanical ventilation, shorter ventilation time, shorter hospital stay, lower incidence of respiratory complications and thoracic deformity and improved pulmonary function. Patients undergoing surgery earlier had shorter time of mechanical ventilation.

Conclusions

Surgical rib fixation with claw-type titanium plate is a reliable and efficient method in the management of patients with flail chest.

Bastos R, Calhoon JH, Baisden CE. Flail chest and pulmonary contusion. Semin Thorac Cardiovasc Surg. 2008;20(1):39–45. doi:10.1053/j.semtcvs.2008.01.004.PubMedCrossRef

Jayle CP, Allain G, Ingrand P, Laksiri L, Bonnin E, Hajj-Chahine J, et al. Flail chest in polytraumatized patients: surgical fixation using Stracos reduces ventilator time and hospital stay. Biomed Research International. 2015;2015:1–6.CrossRef

Nirula R, Allen B, Layman R, Falimirski ME, Somberg LB. Rib fracture stabilization in patients sustaining blunt chest injury. Am Surg. 2006;72(4):307–9.PubMed

Bottlang M, Long WB, Phelan D, Fielder D, Madey SM. Surgical stabilization of flail chest injuries with MatrixRIB implants: a prospective observational study. Injury. 2013;44(2):232–8.PubMedCrossRef

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

Chai X, Lin Q, Ruan Z, Zheng J, Zhou J, Zhang J. The clinical application of absorbable intramedullary nail and claw plate on treating multiple rib fractures. Minerva Chir. 2013;68(4):415–20.PubMed

Bastos R, Calhoon JH, Baisden CE. Flail chest and pulmonary contusion. [J] Semin Thorac Cardiovasc Surg. 2008;20(1):39–45. PMID:18420125. http://www.ncbi.nlm.nih.gov/pubmed/18420125.

Borrelly J, Aazami MH. New insights into the pathophysiology of flail segment: the implications of anterior serratus muscle in parietal failure. Eur J Cardiothorac Surg. 2005;28(5):742–9.PubMedCrossRef

10.

Balci AE, Balci TA, Eren S, Ulku R, Cakir O, Eren N. Unilateral post-traumatic pulmonary contusion: findings of a review. Surg Today. 2005;35(3):205–10. doi:10.1007/s00595-004-2925-z.PubMedCrossRef

11.

Balcı AE, Balcı TA, Eren Ş, Ülkü R, Çakır Ö, Eren N. Unilateral post-traumatic pulmonary contusion: findings of a review. Surg Today. 2005;35(3):205–10.PubMedCrossRef

12.

Sarah M, Quinn C, Granger SR, Vanboerum DH, White TW. Long-term patient outcomes after surgical stabilization of rib fractures. Am J Surg. 2014;208:88–92.CrossRef

13.

Shaik-Dasthagirisaheb YB, Huang N, Weinberg EO, Shen SS, Genco CA, Gibson 3rd FC. Aging and contribution of MyD88 and TRIF to expression of TLR pathway-associated genes following stimulation with Porphyromonas gingivalis. J Periodontal Res. 2015;50(1):89–102. doi:10.1111/jre.12185.PubMedCrossRef

14.

Nirula R, Diaz Jr JJ, Trunkey DD, Mayberry JC. Rib fracture repair: indications, technical issues, and future directions. World J Surg. 2009;33(1):14–22.PubMedCrossRef

15.

Doben AR, Eriksson EA, Denlinger CE, Leon SM, Couillard DJ, Fakhry SM, et al. Surgical rib fixation for flail chest deformity improves liberation from mechanical ventilation. J Crit Care. 2014;29(1):139–43.PubMedCrossRef

16.

Karev D. Operative management of the flail chest. Wiad lek (Warsaw, Poland: 1960). 1996;50:205–8.

17.

Balci AE, Eren S, Cakir O, Eren MN. Open fixation in flail chest: review of 64 patients. Asian Cardiovasc Thorac Ann. 2004;12(1):11–5.PubMedCrossRef

18.

Ahmed Z, Mohyuddin Z. Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation. J Thorac Cardiovasc Surg. 1995;110(6):1676–80.PubMedCrossRef

19.

Nirula R, Allen B, Layman R, Falimirski ME, Somberg LB. Rib fracture stabilization in patients sustaining blunt chest injury. Am Surg. 2006;72:307–9(3).PubMed

20.

Voggenreiter G, Neudeck F, Aufmkolk M, Obertacke U, Schmit-Neuerburg K-P. Operative chest wall stabilization in flail chest—outcomes of patients with or without pulmonary contusion. J Am Coll Surg. 1998;187(2):130–8.PubMedCrossRef

21.

Tanaka H, Yukioka T, Yamaguti Y, Shimizu S, Goto H, Matsuda H, et al. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. Journal of Trauma and Acute Care Surgery. 2002;52(4):727–32.CrossRef

22.

Athanassiadi K, Gerazounis M, Theakos N. Management of 150 flail chest injuries: analysis of risk factors affecting outcome. Eur J Cardiothorac Surg. 2004;26(2):373–6.PubMedCrossRef

23.

Granetzny A, El-Aal MA, Emam E, Shalaby A, Boseila A. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact Cardiovasc Thorac Surg. 2005;4(6):583–7.PubMedCrossRef

24.

Althausen PL, Shannon S, Watts C, Thomas K, Bain MA, Coll D, et al. Early surgical stabilization of flail chest with locked plate fixation. J Orthop Trauma. 2011;25(11):641–7.PubMedCrossRef

Title: Management of patients with flail chest by surgical fixation using claw-type titanium plate
Authors: Xufeng Zhang
Zhiqiang Guo
Chuncheng Zhao
Chenyuan Xu
Zheng Wang
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Journal of Cardiothoracic Surgery / Issue 1/2015
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-015-0363-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Management of patients with flail chest by surgical fixation using claw-type titanium plate

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2015

Surgical repair of inferior sinus venosus defects: a novel approach with unsnared inferior vena cava

Right intra lobar pulmonary sequestration with feeding artery arising from abdominal aorta: a case report

Surgical repair of a giant congenital right atrial aneurysm: a case report

Effect analysis of repeat sternotomy in pediatric cardiac operations

Recurrent candida prosthetic endocarditis over fifteen years managed with medical therapy and four valvular surgeries: a case report and review of literature

Endovascular repair for acute traumatic transection of the descending thoracic aorta: experience of a single centre with a 12-years follow up