Long-term Disability after Flail Chest Injury

Landercasper, Jeffrey; Cogbill, Thomas H.; Lindesmith, Larry A.

doi:10.1097/00005373-198405000-00007

Cited by 95 publications

(18 citation statements)

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“…However, this technique requires prolonged time on the ventilator, resulting in secondary chest infections and persistently high mortality rates of 10–36% in some series [6–9]. Additionally, positive pressure ventilation is not always able to reduce and stabilize the bony injury, resulting in painful fracture nonunion or symptomatic chest wall deformity in 64% of patients in one study [7]. In contrast, operative repair of severe chest wall injury is associated with low long-term morbidity and pain [10].…”

Section: Introductionmentioning

confidence: 99%

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

Fitzpatrick

Denard

Phelan

et al. 2010

Eur J Trauma Emerg Surg

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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.

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Section: Introductionmentioning

confidence: 99%

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

Fitzpatrick

Denard

Phelan

et al. 2010

Eur J Trauma Emerg Surg

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show abstract

“…Of the 6 studies, smoking was reported in only 1 study, in which 46% of the patients smoked. As would be expected, patients without extrathoracic injury had a lower ISS (mean 20.75), although they reported an average of 9.3 (range, [4][5][6][7][8][9][10][11][12][13][14][15] fractures, than those with extrathoracic injury who had a mean ISS of 33, with an average of 7.5 (range, 1-16) fractures. The ISS serves as a standard by providing an overall score from 0 to 75 for patients with multiple injuries.…”

Section: Preinjury Healthmentioning

confidence: 69%

“…12 -17 The 2 studies reporting age-associated outcomes provided dissimilar experiences. 14 Whereas, Landercasper et al 15 found that in patients younger than 65 years, mortality rate was 7% compared with a mortality rate of 29% in those older than 65 years. 14 Whereas, Landercasper et al 15 found that in patients younger than 65 years, mortality rate was 7% compared with a mortality rate of 29% in those older than 65 years.…”

Section: Agementioning

confidence: 98%

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Long-term Outcomes After Blunt Injury to the Boney Thorax

Senn-Reeves

Staffileno

2013

Journal of Trauma Nursing

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Management of blunt injury to the boney thorax centers on the hospital; yet, these injuries continue to impact patients long after hospitalization. The purpose of this literature review was to identify long-term outcomes associated with this injury. A literature search found 616 studies and, after screening, yielded 6 articles for review. Patient and injury characteristics and postinjury assessment findings were explored. The impact of this injury can be prolonged and life altering, prompting the need for further investigation. A greater understanding of injury-specific posthospitalization outcomes could elucidate the impact of these injuries on patients, families, and society.

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“…A significant proportion of patients with chronic flail chest are symptomatic, have abnormal spirometry1 and significant long term disability 2. Operative stabilisation of an acute flail chest is being increasingly recognised as a valuable approach to avoid prolonged ventilation and pneumonia in selected patients.…”

mentioning

confidence: 99%