title: Prospective randomized controlled trial of operative rib fixation in traumatic flail chest.
abstract: BACKGROUND
  Traumatic flail chest injury is a potentially life threatening condition traditionally treated with invasive mechanical ventilation to splint the chest wall. Longer-term sequelae of pain, deformity, and physical restriction are well described. This study investigated the impact of operative fixation in these patients.
  
  
  METHODS
  A prospective randomized study compared operative fixation of fractured ribs in the flail segment with current best practice mechanical ventilator management. In-hospital data, 3-month follow-up review, spirometry and CT, and 6-month quality of life (Short Form-36) questionnaire were collected.
  
  
  RESULTS
  Patients in the operative fixation group had significantly shorter ICU stay (hours) postrandomization (285 hours [range 191 to 319 hours] for the surgical group vs 359 hours [range 270 to 581 hours] for the conservative group; p = 0.03) and lesser requirement for noninvasive ventilation after extubation (3 hours [range 0 to 25 hours] in the surgical group vs 50 hours [range 17 to 102 hours] in the conservative group; p = 0.01). No differences in spirometry at 3 months or quality of life at 6 months were noted.
  
  
  CONCLUSIONS
  Operative fixation of fractured ribs reduces ventilation requirement and intensive care stay in a cohort of multitrauma patients with severe flail chest injury.
authors: CJOB Cardiothoracic Surgery Department, The Alfred Hospital, Melbourne, Australia. s.marasco@alfred.org.au
authors: Silvana F
authors: SF
authors: Marasco
authors: Andrew R
authors: AR
authors: Davies
authors: Jamie
authors: J
authors: Cooper
authors: Dinesh
authors: D
authors: Varma
authors: Victoria
authors: V
authors: Bennett
authors: Rachael
authors: R
authors: Nevill
authors: Geraldine
authors: G
authors: Lee
authors: Michael
authors: M
authors: Bailey
authors: Mark
authors: M
authors: Fitzgerald
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005409:Flail Chest / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery* / Q000628:therapy; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation; D016017:Odds Ratio; D011446:Prospective Studies; D011788:Quality of Life; D012253:Rib Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery* / Q000628:therapy; D013147:Spirometry; D011795:Surveys and Questionnaires; D013898:Thoracic Injuries / Q000150:complications* / Q000628:therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome