Management of patients with flail chest by surgical fixation using claw-type titanium plate

Zhang, Xufeng; Guo, Zhiqiang; Zhao, Chuncheng; Xu, Chenyuan; Wang, Zheng

doi:10.1186/s13019-015-0363-1

Cited by 23 publications

(9 citation statements)

References 18 publications

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“…Nine studies ( n = 1174) reported on implant removal; five studies reported zero events and four studies reported implant removal ranging from 1.5 to 4.9% (Online Appendix 4) [17, 26, 28, 36–38, 40, 45, 48]. Eleven studies reported on wound infection; five studies reported zero events and six studies reported a wound infection rate ranging from 1.7 to 25% [18, 23, 24, 26–30, 46]. Other short and/or long-term complications were poorly reported and described mainly respiratory complications.…”

Section: Resultsmentioning

confidence: 99%

Fixation of flail chest or multiple rib fractures: current evidence and how to proceed. A systematic review and meta-analysis

Beks

Peek

Jong

et al. 2018

Eur J Trauma Emerg Surg

102

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Purpose The aim of this systematic review and meta-analysis was to present current evidence on rib fixation and to compare effect estimates obtained from randomized controlled trials (RCTs) and observational studies. Methods MEDLINE, Embase, CENTRAL, and CINAHL were searched on June 16th 2017 for both RCTs and observational studies comparing rib fixation versus nonoperative treatment. The MINORS criteria were used to assess study quality. Where possible, data were pooled using random effects meta-analysis. The primary outcome measure was mortality. Secondary outcome measures were hospital length of stay (HLOS), intensive care unit length of stay (ILOS), duration of mechanical ventilation (DMV), pneumonia, and tracheostomy. Results Thirty-three studies were included resulting in 5874 patients with flail chest or multiple rib fractures: 1255 received rib fixation and 4619 nonoperative treatment. Rib fixation for flail chest reduced mortality compared to nonoperative treatment with a risk ratio of 0.41 (95% CI 0.27, 0.61, p < 0.001, I 2 = 0%). Furthermore, rib fixation resulted in a shorter ILOS, DMV, lower pneumonia rate, and need for tracheostomy. Results from recent studies showed lower mortality and shorter DMV after rib fixation, but there were no significant differences for the other outcome measures. There was insufficient data to perform meta-analyses on rib fixation for multiple rib fractures. Pooled results from RCTs and observational studies were similar for all outcome measures, although results from RCTs showed a larger treatment effect for HLOS, ILOS, and DMV compared to observational studies. Conclusions Rib fixation for flail chest improves short-term outcome, although the indication and patient subgroup who would benefit most remain unclear. There is insufficient data regarding treatment for multiple rib fractures. Observational studies show similar results compared with RCTs. Electronic supplementary material The online version of this article (10.1007/s00068-018-1020-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Fixation of flail chest or multiple rib fractures: current evidence and how to proceed. A systematic review and meta-analysis

Beks

Peek

Jong

et al. 2018

Eur J Trauma Emerg Surg

102

View full text Add to dashboard Cite

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“…Previous studies show a mean duration of ICU stay of 14 days for patients who had nonoperative treatment for a flail chest with an SD of 4.5 19 20. To detect 3 days difference in ICU stay with a power of 80% and two-sided alpha of 0.05, accounting for 15% loss after propensity score (PS) matching, the total number of patients needed is approximately 82.…”

Section: Methods and Analysismentioning

confidence: 99%

Multicentre prospective cohort study of nonoperative versus operative treatment for flail chest and multiple rib fractures after blunt thoracic trauma: study protocol

et al. 2019

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IntroductionA trend has evolved towards rib fixation for flail chest although evidence is limited. Little is known about rib fixation for multiple rib fractures without flail chest. The aim of this study is to compare rib fixation with nonoperative treatment for both patients with flail chest and patients with multiple rib fractures.Methods and analysisIn this study protocol for a multicentre prospective cohort study, all patients with three or more rib fractures admitted to one of the five participating centres will be included. In two centres, rib fixation is performed and in three centres nonoperative treatment is the standard-of-care for flail chest or multiple rib fractures. The primary outcome measures are intensive care unit length of stay and hospital length of stay for patients with a flail chest and patients with multiple rib fractures, respectively. Propensity score matching will be used to control for potential confounding of the relation between treatment modality and length of stay. All analyses will be performed separately for patients with flail chest and patients with multiple rib fractures without flail chest.Ethics and disseminationThe regional Medical Research Ethics Committee UMC Utrecht approved a waiver of consent (reference number WAG/mb/17/024787 and METC protocol number 17–544/C). Patients will be fully informed of the purpose and procedures of the study, and signed informed consent will be obtained in agreement with the General Data Protection Regulation. Study results will be submitted for peer review publication.Trial registration numberNTR6833

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“…Flail chest is among the most severe chest wall injuries. A flail chest is defined as three or more consecutive rib fractures, in two or more places, creating a flail segment [3,4]. This is the most severe form of rib fractures and this injury is associated with significant morbidity and mortality rates [5].…”

Section: Introductionmentioning

confidence: 99%

Early results after operatively versus non-operatively treated flail chest: a retrospective study focusing on outcome and complications

Wijffels

Hagenaars

Latifi

et al. 2018

Eur J Trauma Emerg Surg

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Purpose Flail chest was traditionally treated non-operatively using mechanical ventilation and pain control. In order to reduce the occurrence of ventilation-associated complications and long-term disability, operative rib fixation is becoming a proven standard therapy for these patients. However, the consequences of the surgical complications may influence success rates negatively. The aim of this study was to compare the outcome of flail chest treatment by surgical rib fixation with nonoperative treatment, with special focus on the impact of surgical complications. Methods A retrospective case series of operatively treated flail chest patients was compared with non-operatively treated patients. Patients' injury and treatment characteristics and outcome parameters (e.g., duration of mechanical ventilation, length of Intensive Care stay (ICLOS) and hospital length of stay (HLOS), mortality, surgery-related complications and pneumonia) were collected from the patients' medical files. Crude and matched-pairs analyses were performed in SPSS. Results Twenty-three operatively and 47 non-operatively treated patients were enrolled. Operatively treated patients required significantly shorter mechanical ventilation; median 4 days versus 12 days for the non-operative group (p = 0.011). The matched-pairs analysis also showed a lower pneumonia rate (35% versus 80%; p = 0.035) and a shorter HLOS (median 21 versus 23 days; p = 0.028) in the operative group. No significant differences in duration of ICLOS, and occurrence of other injury-related adverse events were found between both groups. Seven surgery-related complications occurred, of which three required invasive solutions. Conclusions Operative fixation of a flail chest in trauma patients results in a lower rate of pneumonia, less mechanical ventilation days and shorter hospital stay, compared with non-operative treatment, but at the cost of surgery-related complications requiring invasive solutions in some cases.

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Management of patients with flail chest by surgical fixation using claw-type titanium plate

Cited by 23 publications

References 18 publications

Fixation of flail chest or multiple rib fractures: current evidence and how to proceed. A systematic review and meta-analysis

Fixation of flail chest or multiple rib fractures: current evidence and how to proceed. A systematic review and meta-analysis

Multicentre prospective cohort study of nonoperative versus operative treatment for flail chest and multiple rib fractures after blunt thoracic trauma: study protocol

Early results after operatively versus non-operatively treated flail chest: a retrospective study focusing on outcome and complications

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