Surgical Fixation of Traumatic Flail Chest: An Early Experience at a Major Trauma Centre

Abstract

Purpose: Traumatic flail chest injury is a potentially life threatening condition. Traditionally flail chests were managed with positive pressure ventilation to provide ‘internal splinting’ to the thoracic cage as well as improving oxygenation. However, a few studies recently suggested that some patients might benefit from early fracture fixation, allowing earlier weaning from mechanical ventilation and reducing respiratory complications. We report our very early experience in surgical fib fixation at Liverpool Hospital. Methodology: Four patients with traumatic flail chest underwent surgical rib fixation. Early in 2016 we made a decision to internally fix flail chests based on recent evidence and we report the outcomes of our first four patients. Results: The median age was 57 years old. All patients were male. Two had flail chest from motor vehicle accidents, one fell from a horse and 1 fell from ladder. All had New Injury Severity Score of 16. Number of flail segments ranged from 4 to 7. Lung contusion and pneumothorax were present in 2 patients. All patients were operated within 1 week of injury. There was no surgical mortality. Postoperative non-invasive ventilation (NIV) was needed in 2 patients, lasting 10 and 24 hours respectively. Median total length of stay (LOS) in intensive care unit (ICU) was 9.5 days, postoperative ICU stay was 3 days and hospital stay was 15.5 days. Conclusion: No mortality was associated with surgical fixation of fractured ribs. The LOS and the duration of postoperative NIV were satisfactory. As our experience grows we will be reporting more comprehensive and longer-term outcomes.