title: Better short-term efficacy of treating severe flail chest with internal fixation surgery compared with conservative treatments.
abstract: BACKGROUND
  The objective of the study is to provide evidence for selecting the best treatment approach for severe flail chest by comparing surgical and conservative treatments.
  
  
  METHODS
  This is a retrospective study in which 32 patients with severe flail chest were treated in the Fujian Provincial Hospital (China) between July 2007 and July 2012 with surgical internal rib fixation (n = 17) or conservative treatments (n = 15). Mechanical ventilation time, intensive care unit (ICU) stay time, pulmonary infection, antibiotic treatment duration, acute physiology and chronic health evaluation II (APACHE II) scores 7 and 14 days after trauma, rate of tracheostomy, and rate of endotracheal re-intubation were compared.
  
  
  RESULTS
  One patient died in the conservative treatment group. Better short-term outcomes were observed in the surgery group, such as total mechanical ventilation time (10.5 ± 3.7 vs. 13.7 ± 4.4 days, P = 0.03), ICU stay (15.9 ± 5.0 vs. 19.6 ± 5.0 days, P = 0.05), pulmonary infection rate (58.8 % vs. 93.3 %, P = 0.02), and APACHE II scores on the 14th day (6.5 ± 3.8 vs. 10.1 ± 4.7, P = 0.02). No difference was observed in the therapeutic time of antibiotics, rate of tracheostomy, and the rate of endotracheal re-intubation between the two groups.
  
  
  CONCLUSIONS
  Results suggest that internal fixation surgery resulted in better outcomes in the management of severe flail chest compared with conservative treatments.
authors.affiliation: SICU, Fujian Provincial Hospital, Fujian Medical University Affiliated Provincial Teaching Hospital, Fuzhou, 350001, China. xjq418@163.com.
authors.forename: Jing-Qing
authors.initials: JQ
authors.lastname: Xu
authors.affiliation: SICU, Fujian Provincial Hospital, Fujian Medical University Affiliated Provincial Teaching Hospital, Fuzhou, 350001, China. 516028482@qq.com.
authors.forename: Pei-Li
authors.initials: PL
authors.lastname: Qiu
authors.affiliation: SICU, Fujian Provincial Hospital, Fujian Medical University Affiliated Provincial Teaching Hospital, Fuzhou, 350001, China. yrgmedsci@163.com.
authors.forename: Rong-Guo
authors.initials: RG
authors.lastname: Yu
authors.affiliation: SICU, Fujian Provincial Hospital, Fujian Medical University Affiliated Provincial Teaching Hospital, Fuzhou, 350001, China. 1018813428@qq.com.
authors.forename: Shu-Rong
authors.initials: SR
authors.lastname: Gong
authors.affiliation: SICU, Fujian Provincial Hospital, Fujian Medical University Affiliated Provincial Teaching Hospital, Fuzhou, 350001, China. duozuiwumou@sina.com.
authors.forename: Yong
authors.initials: Y
authors.lastname: Ye
authors.affiliation: SICU, Fujian Provincial Hospital, Fujian Medical University Affiliated Provincial Teaching Hospital, Fuzhou, 350001, China. zksxling@163.com.
authors.forename: Xiu-Ling
authors.initials: XL
authors.lastname: Shang
mesh_terms: D000328:Adult; D005260:Female; D005409:Flail Chest / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000379:methods*