Operative stabilization of flail chest injuries review of literature and fixation options.pdf

REVIEW ARTICLE Operative stabilization of flail chest injuries: review of literature and fixation options D. C. Fitzpatrick ? P. J. Denard ? D. Phelan ? W. B. Long ? S. M. Madey ? M. Bottlang Received: 5 April 2010 / Accepted: 26 April 2010 / Published online: 3 June 2010  The Author(s) 2010. This article is published with open access at S Abstract Background Flail chest injuries cause significant mor- bidity, 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 con- cerning flail chest fixation and describes the different implants and techniques available for fixation. Addition- ally, an illustrative case example is provided for descrip- tion of the surgical approach. Results Two prospective randomized studies, five com- parative 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 defor- mity, and total cost of care. Historically, rib fractures have been stabilized with external plates or intramedullary implants. The use of contemporary, anatomically con- toured 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. Keyword