Surgical rib fixation for flail chest deformity improves liberation from mechanical ventilation.
OBJECTIVE
The goal of this study was to determine the impact of surgical rib fixation (SRF) in a treatment protocol for severe blunt chest trauma.


METHODS
Patients with flail chest admitted between September 2009 and June 2010 to our level I trauma center who failed traditional management and underwent SRF were matched with an historical group. Outcome variables evaluated include age, injury severity score, intensive care unit length of stay (LOS), hospital LOS, ventilator days, total number of rib fractures, and total number of segmental rib fractures.


RESULTS
The 2 groups were similar in age, injury severity score, intensive care unit LOS, hospital LOS, total number of rib fractures, and total segmental rib fractures. The operative group demonstrated a significant reduction in total ventilator days as compared with the nonsurgical group (4.5 [0-30] vs 16.0 [4-40]; P = .040). Patients with SRF were permanently liberated from the ventilator within a median of 1.5 days (0-8 days).


CONCLUSIONS
Surgical rib fixation resulted in a significant decrease in ventilator days and may represent a novel approach to decreasing morbidity in flail chest patients when used as a rescue therapy in patients with declining pulmonary status. Larger studies are required to further identify these benefits.
Department of Surgery, Division of Trauma and Emergency Surgery, Baystate Medical Center, Springfield, MA 01199, USA. Electronic address: Andrew.doben@baystatehealth.org.
Andrew R
AR
Doben
Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA. Electronic address: evsurgery@gmail.com.
Evert A
EA
Eriksson
Division of Cardiothoracic Surgery, MUSC Ashley River Tower, Charleston, SC 29425, USA. Electronic address: denlinge@musc.edu.
Chadrick E
CE
Denlinger
Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA. Electronic address: leon@musc.edu.
Stuart M
SM
Leon
Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA. Electronic address: couild@musc.edu.
Deborah J
DJ
Couillard
Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA. Electronic address: fakhry@musc.edu.
Samir M
SM
Fakhry
Department of Surgery, University of Texas, Southwestern, Dallas, TX 75290, USA. Electronic address: ctminshall@gmail.com.
Christian T
CT
Minshall
D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005409:Flail Chest / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods*; D012253:Rib Fractures / Q000601:surgery*; D013997:Time Factors; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000601:surgery*
Flail chest; Mechanical ventilation; Outcome; Rib fracture; Surgical rib fixation; Trauma