title: Outcomes of Complete Versus Partial Surgical Stabilization of Flail Chest.
abstract: BACKGROUND
  Rib fractures are common after chest wall trauma. For patients with flail chest, surgical stabilization is a promising technique for reducing morbidity. Anatomical difficulties often lead to an inability to completely repair the flail chest; thus, the result is partial flail chest stabilization (PFS). We hypothesized that patients with PFS have outcomes similar to those undergoing complete flail chest stabilization (CFS).
  
  
  METHODS
  A prospectively collected database of all patients who underwent rib fracture stabilization procedures from August 2009 until February 2013 was reviewed. Abstracted data included procedural and complication data, extent of stabilization, and pulmonary function test results.
  
  
  RESULTS
  Of 43 patients who underwent operative stabilization of flail chest, 23 (53%) had CFS and 20 (47%) underwent PFS. Anterior location of the fracture was the most common reason for PFS (45%). Age, sex, operative time, pneumonia, intensive care unit and hospital length of stay, and narcotic use were the same in both groups. Total lung capacity was significantly improved in the CFS group at 3 months. No chest wall deformity was appreciated on follow-up, and no patients underwent additional stabilization procedures following PFS.
  
  
  CONCLUSIONS
  Despite advances in surgical technique, not all fractures are amenable to repair. There was no difference in chest wall deformity, narcotic use, or clinically significant impairment in pulmonary function tests among patients who underwent PFS compared with CFS. Our data suggest that PFS is an acceptable strategy and that extending or creating additional incisions for CFS is unnecessary.
authors.affiliation: Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
authors.forename: Terry P
authors.initials: TP
authors.lastname: Nickerson
authors.affiliation: Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
authors.forename: Cornelius A
authors.initials: CA
authors.lastname: Thiels
authors.affiliation: Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Kim
authors.affiliation: Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Zielinski
authors.affiliation: Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
authors.forename: Donald H
authors.initials: DH
authors.lastname: Jenkins
authors.affiliation: Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. schiller.henry@mayo.edu.
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Schiller
mesh_terms: D000328:Adult; D005260:Female; D005409:Flail Chest / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D012253:Rib Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome