No benefit to surgical fixation of flail chest injuries compared with modern comprehensive management: results of a retrospective cohort study

Farquhar, Jaclyn; Almahrabi, Yahya; Slobogean, Gerard P.; Slobogean, Bronwyn; Garraway, Naisan; Simons, Richard K.; Hameed, S. Morad

doi:10.1503/cjs.000515

Cited by 51 publications

(39 citation statements)

References 14 publications

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“…More and more evidence shows the benefits of surgical fixation of flail chests over non-operative management [15][16][17][18]. Although recent evidence-based guidelines advise surgical fixation in flail chest patients [19,20], the benefit of rib fixation is not unanimous and needs more comparative studies [21,22]. However surgical techniques may overcome conservative complications, it may introduce the risk of surgical side-effects.…”

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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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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“…There were no significant differences in long-term outcomes, such as chest pain or dyspnea. 14 Our research suggests that rib fixation can shorten the ICU length of stay and duration of ventilation in patients with flail chest. In all patients, rib fixation can significantly shorten the length of hospitalization and recovery time to regular life, suggesting that rib fixation is beneficial for patients with flail chest or chest wall deformity.…”

Section: Discussionmentioning

confidence: 74%

A new instrument for surgical stabilization of multiple rib fractures

Xiong

Yuyang

et al. 2019

J Int Med Res

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Objective Rib fixation is an effective treatment for patients with multiple rib fractures. We retrospectively evaluated the application of a four-claw titanium plate in patients with rib fractures. Methods Fifty-four patients treated for multiple rib fractures in our hospital from 2012 to 2016 were divided into a surgery group (n = 27) and conservative treatment group (n = 27). The patients’ age, sex, cause of fracture, Injury Severity Score, chest Abbreviated Injury Scale score, number of ventilator days, and length of hospitalization were recorded. Results The mean duration of mechanical ventilation was 4.5 ± 0.7 and 7.9 ± 1.7 days in the surgery and control group, respectively, with a significant difference. The length of intensive care unit stay was also significantly different between the groups (5.9 ± 0.6 vs. 10.6 ± 1.9 days, respectively). The length of hospital stay and recovery time to regular life in the surgery and control group were 11.5 ± 1.9 and 3.9 ± 4.0 days and 38.2 ± 8.3 and 60.8 ± 12.1 days, respectively, both with significant differences. Conclusion A four-claw titanium plate is valuable for patients with multiple rib fractures, allowing easy fixation of broken ribs beneath the scapula, even the second rib.

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“…Three recent meta-analyses confirm these findings, and suggest a mortality benefit as well (15)(16)(17). The verdict has not been unanimous, though; at least two recent retrospective studies have failed to show a benefit to surgical stabilization in patients with flail segment (18,19). Others have demonstrated flaws in these dissenting studies, however, regarding methodology, timing of intervention, confounding injuries, and patient selection (7).…”

Section: Indications For Surgerymentioning

confidence: 97%

Blunt chest trauma: is there a place for rib stabilization?

Mitchell¹

2017

J. Thorac. Dis.

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No benefit to surgical fixation of flail chest injuries compared with modern comprehensive management: results of a retrospective cohort study

Cited by 51 publications

References 14 publications

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

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

A new instrument for surgical stabilization of multiple rib fractures

Blunt chest trauma: is there a place for rib stabilization?

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