The introduction of rib fracture fixation for traumatic flail chest injury: A single centre experience

Abstract

Introduction High energy chest trauma resulting in flail chest injury or multiple rib fractures is associated with increased rates of patient morbidity and mortality. Operative fixation of acute rib fractures causing flail chest is thought to reduce morbidity by reducing pain and improving chest mechanics enabling earlier ventilator weaning. A variety of operative techniques have been described historically and we report on our unit’s experience of the introduction of acute rib fracture fixation using contoured locking plates. Methods Between December 2010 and 2011, 10 patients underwent acute rib fracture fixation under the joint care of orthopaedic and thoracic surgeons. Outcome measures included patient demographics, time ventilated pre-operatively, time ventilated post-operatively and time spent on intensive treatment unit/high dependency unit (ITU/HDU) post operatively. Results The median time from presentation to surgery was 5 days (range 2–12 days), the median time ventilated post-operatively was 2 days (range 1–4 days) and the median number of days spent on ITU/HDU post-operatively was 6 days (range 2–11 days). All but two patients, who did not require post-operative ventilation, were weaned off the ventilator within 4 days of surgery. Conclusions Our results appear positive in terms of time spent ventilated post-operatively but no conclusion can be drawn as we have no comparable non-operative group. We have however shown that rib fracture fixation can be carried out successfully and safely in a trauma centre with few post-operative complications reported to date. Further evidence on rib fracture fixation is required from a large, multi-centre randomised controlled trial.