title: A feasibility study of 60 consecutive patients operated for unstable thoracic cage.
abstract: BACKGROUND
  About 10% of adult patients in high-energy trauma sustain multiple rib fractures. Some of these patients suffer from flail chest leading to respiratory insufficiency. During last years interest and results for operative treatment has improved. The literature today all show positive results for surgical versus conservative treatment, specifically with regard to time spent in mechanical ventilator, complication rates and length of hospital stay.
  
  
  METHODS
  Between September 2010 and July 2012, 60 patients with flail chest or multiple rib-fractures resulting in unstable thoracic cage were operated. 16 women and 44 men with an age between 19-86 years (mean 57). We used modern fracture techniques with plates and intramedullary splint. Thoracotomy was performed and lung lacerations were debrided (11/60). Time spent in ventilator, complications and other adverse effects was studied. The operated cohort was compared to results from six previous years, when none was operated for that diagnose (153 patients).
  
  
  RESULTS
  There is a significant correlation between Injury Severity Score (ISS) and time spent in ventilator both for patients operated and not operated (p< 0,01). The mean time in ventilator was 9,01 days for not operated patients compared to 2,7 for the operated (p<0,0001). No clear pneumonias were found. We had two deaths during the acute period. The infection rate was low.
  
  
  CONCLUSIONS
  Open reduction and internal fixation is a safe method to treat the unstable thoracic cage with multiple rib fractures and flail chest. Complication are few. The treatment time in mechanical ventilator is significant decreased. The operative treatment is probably cost effective and can be recommended. Knowledge in thoracic surgery and modern fracture surgery is needed. This is a therapeutic consecutive, level III, cohort study with historical controls.
authors: Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Hans P
authors: HP
authors: Granhed
authors: Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: David
authors: D
authors: Pazooki
keywords: Flail chest; Operation; Rib fractures; Treatment
references: Fa Yi Xue Za Zhi. 2007 Dec;23 (6):431-3, 437
references: 18402113
references: Interact Cardiovasc Thorac Surg. 2005 Dec;4(6):583-7
references: 17670487
references: Thorac Cardiovasc Surg. 2000 Feb;48(1):1-8
references: 10757149
references: J Bone Joint Surg Am. 2011 Jan 5;93(1):97-110
references: 21209274
references: J Trauma. 2008 Feb;64(2):304-10
references: 18301191
references: J Am Coll Surg. 1998 Aug;187(2):130-8
references: 9704957
references: BMJ. 2008 Oct 02;337:a1518
references: 18832412
references: Am J Surg. 2012 Dec;204(6):910-3; discussion 913-4
references: 23036605
references: J Orthop Trauma. 2011 Nov;25(11):648
references: 22008859
references: Osteoporos Int. 2004 Aug;15(8):649-53
references: 15042281
references: Scand J Trauma Resusc Emerg Med. 2012 Feb 02;20:11
references: 22301065
references: J Orthop Trauma. 2011 Nov;25(11):641-7
references: 22008858
references: J Am Coll Surg. 2012 Aug;215(2):201-5
references: 22560319
references: Calcif Tissue Int. 1998 Mar;62(3):274-7
references: 9501963
references: Ann Adv Automot Med. 2008 Oct;52:73-82
references: 19026224
references: J Trauma. 1994 Dec;37(6):975-9
references: 7996614
references: J Am Coll Surg. 2003 Apr;196(4):549-55
references: 12691929
references: Acta Chir Orthop Traumatol Cech. 2011;78(3):258-61
references: 21729644
references: Korean J Thorac Cardiovasc Surg. 2012 Aug;45(4):246-50
references: 22880170
references: J Trauma. 2002 Apr;52(4):727-32; discussion 732
references: 11956391
references: Lakartidningen. 2000 Oct 18;97(42):4760-2
references: 11079329
references: Eur J Trauma Emerg Surg. 2010 Oct;36(5):407-15
references: 21841952
references: BMJ. 2010 Mar 15;340:c1069
references: 20231246
references: Eur J Trauma Emerg Surg. 2010 Oct;36(5):417-26
references: 21841953