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PubMed2006

[Surgical stabilization of multiple rib fracture and flail chest].

The experience of 14 cases with surgical stabilization of multiple rib fracture and flail chest was reported. They were 11 men and 3 women of 31 to 87 years of age. Paradoxical chest movement was noted in 10 patients. Thirteen of 14 patients successfully weaned from the ventilator less than 7 days after surgery. Of 14, 4 cases were treated with internal fixation and the others were with acetabular reconstruction plates with or without rib stapler. No case of death was experienced. Ten patients who were performed fixation with acetabular reconstruction plate weaned from the ventilator earlier than cases treated by internal fixation, suggesting the superiority of the acetabular reconstruction plate. Improvement of rib stapler and the development of a titanium plate of specific use for rib is expected in the future.

Adult↗
PubMed1975

Surgical stabilization of traumatic flail chest.

Since 1970 we have stabilized the ribs to correct paradoxical movement of the chest wall in chest injuries, using an original technique, in order to avoid as far as possible the need for long-term chest wall stabilization by intermittent positive pressure respiration (IPPR). The technical details of surgical stabilization are described, and the different types of stainless steel struts are shown. Type I was originally used either as an intramedullary nail or as an external brace. Types II and III were designed for external fixation of the strut to the rib. Treatment of 29 patients with severe flail chest, classified into four groups is shown: group I was treated by IPPR, group II by IPPR plus surgical stabilization, group III by surgical stabilization only, and group IV by surgical stabilization after exploratory thoracotomy. The clinical results are discussed. We conclude that surgical stabilization of the paradoxial movement of the chest wall can avoid the use of the respirator or at least reduce the interval of IPPR to a short period during the initial recovery from trauma. Using type III struts, we have obtained stabilization of the flail chest in all cases even in patients with severe anterior paradoxical movement. The patients' tolerance of surgical stainless steel struts was good.

Humans↗
PubMed1981

[Compared results of flail chests treatments : standard internal pneumatic stabilization, new technics of assisted ventilation, osteosynthesis (author's transl)].

The analysis of 170 cases of flail chests, divide into three groups according to the type of treatment, proves the efficiency of the new technics of assisted ventilation and of the osteosynthesis by Judet clasps. The most significant advantages of those two complementary methods are a lowered mortality rate and a reduced frequency of refractory hypoxy and infectious complications.

Adult↗
PubMed2006

Unilateral flail chest is seldom a lethal injury.

BACKGROUND: The chest cage is a common target for traumatic damage. Although relatively rare, it is considered to be a serious condition with significant reported mortalities. As most flail injuries are accompanied by severe extrathoracic injuries, it is often difficult to pinpoint a single injury responsible for the patient's death. AIM: To investigate the factors related to mortality when flail injury is diagnosed. METHODS: Data from the Israel National Trauma Registry between 1998 and 2003 included 11,966 chest injuries (262 flail chest injuries) out of a total of 118,211 trauma hospitalisations. Mortality figures were analysed to determine which factors, singly or in combination, influenced flail chest mortality. RESULTS: Road crashes accounted for most flail injuries (76%). The total mortality was 54 (20.6%) of 262 patients with flail chest injuries. 13 (20.4%) of the deaths occurred soon after admission to the emergency room and 37 (68.5%) within the first 24 h. Mortality in moderate to severe injuries (injury severity score (ISS) 9-24) was 3.6% and that in critical injuries 28.5% (ISS >24). Mortality increased with age: 17% in those aged <45 years, 22.1% in those between 45 and 64 years and 28.8% in those >65 years. Age remained a risk for inpatient death when adjusted for severity. Mortality in isolated unilateral flail injury was not more than 6%. Total mortality for traumatic brain injury (TBI) and flail was 34%. Flail, TBI and other major injuries increased the mortality to 61.1%. CONCLUSIONS: Advanced age is associated with higher mortality. Isolated unilateral bony cage instability infrequently leads to death in patients who make it to the emergency department but rather its combination with additional extrathoracic trauma.

Accidents, Traffic↗
PubMed1990

[A rare case of airway foreign bodies complicated with flail chest following traffic accident].

A 30-year-old man was taken to the emergency room of this hospital because of chest injury following traffic accident. On arrival he was found to be dyspneic due to multiple rib fractures (flail chest) and tension pneumothorax on the left, and was intubated immediately concomitantly with a chest drainage. During the management with the respirator, he was also noticed to have continuous bleeding from the airway. The X-ray film of the chest showed a suspicion of foreign materials on the right hilar region and subsequent bronchoscopic examination revealed the presence of several fragments of a broken windshield in the bronchial trees. Nine fragments were removed bronchoscopically. Tracheal tube was extubated on the 14th day and he was discharged on the 28th day without any sequela.

Accidents, Traffic↗
PubMed2002

Flail chest secondary to excessive rib resection in idiopathic scoliosis: case report.

STUDY DESIGN: Case report. OBJECTIVES: To report a previously undescribed complication of scoliosis surgical treatment. SUMMARY OF BACKGROUND DATA: None available. METHODS: Clinical case analysis. RESULTS: Excessive rib resection resulted in a permanent "flail" chest. CONCLUSION: Rib resection ("costoplasty") is a valuable procedure for obtaining bone graft and for esthetic reduction of rib prominence, but excessive removal and especially done twice can produce major disability.

Adolescent↗
PubMed1975

Control of respiratory therapy in flail chest.

Pulmonary mechanics and oxygenation were measured in 24 consecutive patients with posttraumatic flail chest requiring continuous mechanical ventilation. The mean duration of mechanical ventilation was fourteen days. Mortality was 38% for all patients, 29% if deaths from head injury are excluded. Pneumonia occurred in 4 patients (17%) and pneumothorax in 1 (4%). Vital capacity and maximal inspiratory force measurements were useful in assessing chest wall stabilization. Total lung compliance correlated negatively with fatal outcome from respiratory failure. The alveolar-arterial oxygen gradient was not useful in assessing chest wall stabilization.

Adult↗
PubMed2001

Successful transdiaphragmatic cardiac resuscitation through midline abdominal incision in patient with flail chest.

This case report describes a transdiaphragmatic approach through an already present vertical midline abdominal incision for performing internal cardiac compressions in a 30-year-old male road accident victim. The patient had a flail chest with haemopneumothorax and haemoperitoneum. Exploratory laparotomy followed by splenectomy was performed under general anaesthesia but the patient developed a witnessed cardiac arrest in postoperative period. Successful resuscitation using internal cardiac compression by a transdiaphragmatic approach through the midline abdominal incision that was not extended proximally is described.

Accidents, Traffic↗
PubMed1987

Flail chest injury in a patient with surgical absence of the sternum.

Although pulmonary disability is usually minimal following total sternectomy, the potential for remote complications exists. We present a case of severe respiratory failure resulting from simple rib fractures occurring two years after sternectomy for sternal osteomyelitis. Respiratory failure resulted from flail chest due to the combination of acute rib fracture and the lack of anterior fixation of the thoracic cage.

Aged↗
PubMed1978

[The fixation of the flail chest with tension band wires (author's transl)].

A new technique of internal fixation of the flail chest was tested successfully in sheep. After reduction a 0.8 mm wire is passed twice intramedullary across the fracture and twisted under tension with two loops on the external side of the rib. This wire neutralizes bending and rotational forces and produces axial interfragmental compression. Combined with tension band wire fixation of an eventually fractures sternum it produced sufficient stability even in the very thin parasternal part of ribs. No respiratory support was necessary postoperatively. The method is simple and needs no special equipment.

Animals↗
PubMed1977

[Original surgical technic for the treatment of flail chest (author's transl)].

Solid internal fixation of fractures of the ribs and thorax producing a flail chest is described using a new technic which permits early mobilisation of the patient, immediate spontaneous respiration, abolition of pain, early respiratory physiotherapy, and reduces the danger of respiratory complications due to artificial ventilation, and permenent sequelae due to a secondary deformity of the thoracic cage. Our experience of the method has permitted us to determine its indications and limits.

Fracture Fixation, Internal↗
PubMed1981

Flail chest.

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Flail Chest↗
PubMed1977

5. New approaches to the management of flail chest.

Although continuous positive-pressure ventilation (internal pneumatic fixation) was a great advance in the treatment of flail chest and is now the standard treatment of this condition, early and late complications related to tracheostomy and long-term ventilation are associated with this method. These complications can be avoided by use of three recently adopted techniques--expectant therapy, intermittent mandatory ventilation with positive end-expiratory pressure, and early surgical stabilization of fractures. All patients should continue to be treated in intensive care units so that impending respiratory failure can be identified and treated. These newer forms of therapy not only have the advantages of avoiding complications inherent in tracheostomy and prolonged ventilation, but also decrease the length of hospital stay and expense of treatment.

Bone Plates↗