Quantitative assessment of the posttreatment lung volume changes in patients with flail chest on computed chest tomography images

Abstract

Complications encountered in the chronic phase in flail chest patients are a decrease in lung volume due to chest wall deformities and secondary restrictive respiratory function disorders. The aim of the study was to determine the differences in lung volume changes between flail chest patients who were treated non-surgically and those who were treated with surgical stabilisation. The study was conducted on twenty patients who applied to our clinic and were diagnosed with flail chest. There were ten patients in the non-surgically treated group and ten in the surgical stabilisation group. Computed tomography (CT) images of the patients were received before the treatment and in the third post-operative month. Total lung volumes were estimated on CT images using the planimetry method of the Cavalieri principle. The relationship between the treatment method and volume changes was analysed. While the total lung volume increased 12.9% post-operatively in the non-surgically treated group, it increased 36.9% in the surgical stabilisation group (p<0.05). In those cases of hemithorax affected by trauma, the increase in volume in the surgical stabilisation group was 41.6 (34.6%), but it was 7.7 (10%) in the non-surgically treated group (p<0.05). In the contralateral hemithorax, the increase observed in the stabilisation group was 42.6 (39.2%) while the increase in the non-surgical treated group was 19.6 (13.9%) (p>0.05). Our findings showed that the post-operative total lung volume increase in the surgically treated group of patients was greater than that of the conservative group. If there are no preventive factors for the surgical approach, surgical rib stabilisation could be the primary choice of treatment in flail chest patients.