Indications and Surgical Treatment of the Traumatic Flail Chest Syndrome. An Original Technique

BackgroundFlail chest injuries cause significant morbidity, especially in multiply injured patients. Standard treatment is typically focused on the underlying lung injury and involves pain control and positive pressure ventilation. Several studies suggest improved short- and long-term outcomes following operative stabilization of the flail segments. Despite these studies, flail chest fixation remains a largely underutilized procedure.MethodsThis article reviews the relevant literature concerning flail chest fixation and describes the different implants and techniques available for fixation. Additionally, an illustrative case example is provided for description of the surgical approach.ResultsTwo prospective randomized studies, five comparative studies, and a number of case series documented benefits of operative treatment of flail chest injuries, including a decreased in ventilation duration, ICU stay, rates of pneumonia, mortality, residual chest wall deformity, and total cost of care. Historically, rib fractures have been stabilized with external plates or intramedullary implants. The use of contemporary, anatomically contoured rib plates reduced the need for intraoperative plate bending. Intramedullary rib splints allowed less-invasive fixation of posterior fractures where access for plating was limited.ConclusionOperative treatment can provide substantial benefits to patients with flail chest injuries and respiratory compromise requiring mechanical ventilation. The use of anatomically contoured rib plates and intramedullary splints greatly simplifies the procedure of flail chest fixation.

Section: Implantsmentioning

confidence: 99%

Section: Implantsmentioning

confidence: 99%

Operative stabilization of flail chest injuries: review of literature and fixation options

Fitzpatrick

Denard

Phelan

et al. 2010

“…This review identified essential aspects of rib fracture fixation with plates and intramedullary devices: an advanced plating solution should provide a low-profile fixation construct [7], reduce the need for intraoperative plate contouring [3], allow for spanning and suspension of a flail segment with long plates [18, 19], match the low stiffness of ribs to restore physiologic rib function [9, 20], and it should deliver durable and strong fixation. A comprehensive strategy for rib fracture fixation should furthermore include an IM fixation option for stabilization of posterior fractures that prevents the implant migration and cut-out observed with Kirschner wires.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical rationale and evaluation of an implant system for rib fracture fixation

Bottlang

Walleser

Noll

et al. 2010

BackgroundBiomechanical research directed at developing customized implant solutions for rib fracture fixation is essential to reduce the complexity and to increase the reliability of rib osteosynthesis. Without a simple and reliable implant solution, surgical stabilization of rib fractures will remain underutilized despite proven benefits for select indications. This article summarizes the research, development, and testing of a specialized and comprehensive implant solution for rib fracture fixation.MethodsAn implant system for rib fracture fixation was developed in three phases: first, research on rib biomechanics was conducted to better define the form and function of ribs. Second, research results were implemented to derive an implant system comprising anatomical plates and intramedullary rib splints. Third, the functionality of anatomic plates and rib splints was evaluated in a series of biomechanical tests.ResultsGeometric analysis of the rib surface yielded a set of anatomical rib plates that traced the rib surface over a distance of 13–15 cm without the need for plate contouring. Structurally, the flexible design of anatomic plates did not increase the native stiffness of ribs while restoring 77% of the native rib strength. Intramedullary rib splints with a rectangular cross-section provided 48% stronger fracture fixation than traditional intramedullary fixation with Kirschner wires.ConclusionThe anatomic plate set can simplify rib fracture fixation by minimizing the need for plate contouring. Intramedullary fixation with rib splints provides a less-invasive fixation alternative for posterior rib fracture, where access for plating is limited. The combination of anatomic plates and intramedullary splints provides a comprehensive system to manage the wide range of fractures encountered in flail chest injuries.

“…The Judet [28] and Sanchez [38] plates are similar to the Labitzke plate. They all use the principle of grasping the relatively soft bone of the ribs with flat hooks instead of relying on screws.…”

Section: External Supportmentioning

confidence: 99%

Historic overview of treatment techniques for rib fractures and flail chest

Bemelman

Poeze

Blokhuis

et al. 2010

IntroductionFrom the beginning of the twentieth century till the current time, an overview is presented of the surgical treatment for rib fractures and flail chest.MethodsMany techniques have been used to stabilize the thorax wall. There has been no follow-up for the most described techniques and the evidence provided is at its best at L3–4. This, together with the noninvasiveness of mechanical ventilation, has made the latter the golden standard.ConclusionHowever, the recent introduction of better and fully dedicated materials provides the possibility of exploring the surgical treatment of chest injuries. The authors make a case for operative treatment of rib fractures and flail chest.