title: Severe trauma of the chest wall: surgical rib stabilisation versus non-operative treatment.
abstract: BACKGROUND
  Serial rib fractures and flail chest injury can be treated by positive-pressure ventilation. Operative techniques reduce intensive care unit (ICU) stay, overall costs, mortality and morbidity, as well as pain. The aim of this study was to evaluate the benefit of surgical rib stabilisation in comparison to non-operative treatment in patients with severe trauma of the chest wall.
  
  
  METHODS
  From 2006 to 2011, the data of 44 patients with flail chest and serial rib fractures were collected retrospectively. A surgical group and an intensive care group with only intensive care therapy were formed. Rib and sternal fractures, flail chest, injury severity, thoracic injuries, mechanical ventilation, time in the ICU, overall hospital stay and mortality were evaluated.
  
  
  RESULTS
  No postoperative surgical complications had been observed. The time under mechanical ventilation in the surgical group was 10.6 ± 10.2 days, whereas in the non-surgical group, it was 13.7 ± 13.7 days. Mechanical ventilation time after surgery was 6.9 ± 6.5 days. Time in the ICU for the surgical group was 16.4 ± 13.6 days, compared to the non-surgical group with 20.1 ± 16.2 days. Postoperative time in the ICU was 11.7 ± 10.3 days. The mortality in the surgical group was 10 % and in the non-surgical group it was 17 %.
  
  
  CONCLUSIONS
  Operative rib stabilisation with plates is a safe therapy option for severe trauma of the chest wall. Provided that the duration of preoperative mechanical ventilation and time spent in the ICU is minimised due to early operation, our data suggest that the stabilisation of serial rib fractures and flail chest may lead to a reduced time of mechanical ventilation, time in the ICU and mortality.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Westpfalz-Klinikum Kaiserslautern, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Germany. mmuhm@westpfalz-klinikum.de.|Department of Trauma and Orthopaedic Surgery, Medical Faculty Mannheim, Heidelberg University and Mainz University, Heidelberg, Germany. mmuhm@westpfalz-klinikum.de.
authors.forename: M
authors.initials: M
authors.lastname: Muhm
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Medical Faculty Mannheim, Heidelberg University and Mainz University, Heidelberg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Härter
authors.affiliation: Department of Medical Statistics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Weiss
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Medical Faculty Mannheim, Heidelberg University and Mainz University, Heidelberg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Winkler
keywords: Flail chest; Hospital stay; Mechanical ventilation; Serial rib fracture; Surgical rib stabilisation; Thoracic injury
references.citation: Thorac Cardiovasc Surg. 1981 Oct;29(5):275-81
references.pmid: 6179200
references.citation: Chirurg. 1986 Jan;57(1):1-14
references.pmid: 3956322
references.citation: Eur J Trauma Emerg Surg. 2010 Oct;36(5):417-26
references.pmid: 21841953
references.citation: Unfallchirurg. 1991 Mar;94(3):129-33
references.pmid: 2052941
references.citation: J Thorac Cardiovasc Surg. 1995 Dec;110(6):1676-80
references.pmid: 8523879
references.citation: J Trauma. 1974 Mar;14(3):187-96
references.pmid: 4814394
references.citation: J Thorac Cardiovasc Surg. 1975 Oct;70(4):619-30
references.pmid: 1100923
references.citation: Eur J Trauma Emerg Surg. 2010 Oct;36(5):407-15
references.pmid: 21841952
references.citation: Am J Surg. 1985 Sep;150(3):324-6
references.pmid: 4037191
references.citation: Interact Cardiovasc Thorac Surg. 2005 Dec;4(6):583-7
references.pmid: 17670487
references.citation: Injury. 2013 Feb;44(2):232-8
references.pmid: 22910817
references.citation: J Am Coll Surg. 1998 Aug;187(2):130-8
references.pmid: 9704957
references.citation: Ann Thorac Surg. 1975 Apr;19(4):355-63
references.pmid: 235908
references.citation: Am J Surg. 1976 Dec;132(6):759-62
references.pmid: 998864
references.citation: Thorac Cardiovasc Surg. 1982 Oct;30(5):294-7
references.pmid: 6183778
references.citation: J Trauma. 2000 Feb;48(2):319-21
references.pmid: 10697096
references.citation: J Thorac Surg. 1956 Sep;32(3):291-311
references.pmid: 13358119
references.citation: Ann Surg. 1982 Oct;196(4):481-7
references.pmid: 7125734
references.citation: J Trauma. 2002 Apr;52(4):727-32; discussion 732
references.pmid: 11956391
references.citation: Eur J Cardiothorac Surg. 2001 Sep;20(3):496-501
references.pmid: 11509269
references.citation: J Trauma. 1990 Dec;30(12):1460-8
references.pmid: 2258956
references.citation: Am Surg. 2009 May;75(5):389-94
references.pmid: 19445289
references.citation: Thorac Cardiovasc Surg. 1997 Oct;45(5):242-4
references.pmid: 9402664
references.citation: J Trauma. 1984 May;24(5):410-4
references.pmid: 6716518
references.citation: Eur J Trauma Emerg Surg. 2010 Oct;36(5):427-33
references.pmid: 21841954
references.citation: J Thorac Cardiovasc Surg. 1978 Jun;75(6):793-801
references.pmid: 661347