Abstract
Objectives: The performance and timing of surgical fixation of multiple simple rib fractures and flail chest wall remains controversial. We report our experience with acute and delayed multiple simple rib fracture and flail chest wall surgical fixation. Methods: Since December 2006, 46 patients had surgical fixation using external titanium plates and bicortical screws for either multiple simple rib fractures or flail chest. We analysed operation details, hospital stay and complications. Results: 29 patients [Group 1, 21 males, median age 54 (range 31-77) years] underwent fixation within 6 days following injury (range 1-43). Indications included: significant deformity/displacement, n= 19; respiratory failure, n= 6; uncontrolled pain, n = 3; persistent pneumothorax, n= 1. 17 patients [Group 2, 12 males, median age 58 (range 25-76) years] had delayed fixation at 12 (range 4-159) months following injury due to persistent pain, dyspnoea or deformity. 24 patients in Group 1 had flail chest vs 5 in Group 2 (P < 0.001). Critical care stay was zero in Group 2. Eighteen patients in Group 1 had median critical care stay of 4 (range 0.5-34) days. Postoperative length of stay (PLOS) was longer in Group 1 for both flail chest and multiple simple rib fractures (13.6 ± 10 days vs 3.6 ± 0.6 days, P =0 .1, and 7.4 ±3 .8 days vs 7 ± 1.7 days, P = 0.01, respectively). Nine patients in Group 1 (31%) developed complications (chest infection, n = 5; sputum retention, n =1 ; deep wound infection, n = 1; prolonged respiratory wean, n = 1; internal jugular vein thrombosis, n = 1) vs 3 patients in Group 2 (17.6%, P =N S; surgical infection, n = 1; neurogenic pain, n =1 ; haemothorax,n =1 ). Although symptomatic improvement was noted in most Group 2 patients, 18% had persistent pain. Conclusions: Fixation of multiple rib fractures is safe and effective in both the acute and delayed setting. Patients undergoing acute repair have an acceptable critical care stay. Although early repair is recommended, delayed fixation may still be of benefit. Disclosure: All authors have declared no conflicts of interest. Interactive CardioVascular and Thoracic Surgery
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