Combining the use of Nuss procedure and rib fixation for severe flail chest: a case report

Quanwei Guo,Jinghui Zhang,Kaican Cai,Jianhua Zhang

doi:10.1186/s12893-020-00747-2

Abstract

BackgroundSevere flail chest is a life-threatening situation. The Nuss procedure is a new effective treatment for severe flail chest patients who cannot be weaned from prolonged mechanical ventilation in the last few years. However, the procedure is not suitable when there are multiple fractures in both the anterior and lateral chest walls. Here, we reported a rare case of severe flail chest in a patient who suffered multiple fractures in both the anterior and lateral chest walls in a traffic accident.Case presentationA 49-year-old patient suffered severe flail chest by a steering wheel in a traffic accident with multiple fractures in both the anterior and lateral chest walls. In the beginning, the patient was administrated with mechanical ventilation because of acute respiratory distress syndrome (ARDS) for more than 1 week. Then the patient suffered from a severe lung infection and decreased blood oxygen saturation. After a multidiscipline discussion (MDT), three rib fixation plates were first used to rebuild the stability of lateral chest walls, then two Nuss bars were inserted to eliminate paradoxical movement in the anterior chest wall. Finally, the patient recovered smoothly after the combining procedure.ConclusionsSevere flail chest patients with both the anterior and lateral chest walls after trauma are in a life-threatening situation, and require an appropriate procedure to get out of danger in time. Rib fixation is an effective treatment when the fractured sites are few and the fractured area is small. The Nuss procedure is a new effective method for severe flail chest with multiple fractures in an anterior chest wall, which is also a minimally invasive and short time-consuming procedure. However, it does not suitable for the patient with multiple fractures in lateral chest walls. Combining the use of Nuss procedure and rib fixation can solve severe flail chest with multiple ribs and sternum fractures in both the anterior and lateral chest walls, and the outcome of this procedure is satisfying in the present rare case.

Highlights

Severe flail chest is a life-threatening situation
Severe flail chest patients with both the anterior and lateral chest walls after trauma are in a lifethreatening situation, and require an appropriate procedure to get out of danger in time
Combining the use of Nuss procedure and rib fixation can solve severe flail chest with multiple ribs and sternum fractures in both the anterior and lateral chest walls, and the outcome of this procedure is satisfying in the present rare case

Summary

Introduction

Severe flail chest is a life-threatening situation. The Nuss procedure is a new effective treatment for severe flail chest patients who cannot be weaned from prolonged mechanical ventilation in the last few years. The Nuss procedure has been reported to repair pectus excavatum by elevating the depressed chest wall since 1998 [3] It has been used for surgical treatment of severe flail chest recently, providing good outcomes whether flail chest is caused by trauma [4,5,6,7,8,9] or disease [10]. We reported a rare case of severe flail chest in a patient who suffered multiple fractures in both the anterior and lateral chest walls in a traffic accident. Our report proved that combining the use of the Nuss procedure and rib fixation was a feasible and effective strategy for this situation with satisfying surgery outcomes

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Discussion

Conclusion