title: No benefit to surgical fixation of flail chest injuries compared with modern comprehensive management: results of a retrospective cohort study.
abstract: Chest wall trauma is a common cause of morbidity and mortality. Recent technological advances and scientific publications have created a renewed interest in surgical fixation of flail chest. However, definitive data supporting surgical fixation are lacking, and its virtues have not been evaluated against modern, comprehensive management protocols.
  
  
  
  Consecutive patients undergoing rib fracture fixation with rib-specific locking plates at 2 regional trauma centres between July 2010 and August 2012 were matched to historical controls with similar injury patterns and severity who were managed nonoperatively with modern, multidisciplinary protocols. We compared short- and long-term outcomes between these cohorts.
  
  
  
  Our patient cohorts were well matched for age, sex, injury severity scores and abbreviated injury scores. The nonoperatively managed group had significantly better outcomes than the surgical group in terms of ventilator days (3.1 v. 6.1, p = 0.012), length of stay in the intensive care unit (3.7 v. 7.4 d, p = 0.009), total hospital length of stay (16.0 v. 21.9 d, p = 0.044) and rates of pneumonia (22% v. 63%, p = 0.004). There were no significant differences in long-term outcomes, such as chest pain or dyspnea.
  
  
  
  Although considerable enthusiasm surrounds surgical fixation of flail chest injuries, our analysis does not immediately validate its universal implementation, but rather encourages the use of modern, multidisciplinary, nonoperative strategies. The role of rib fracture fixation in the modern era of chest wall trauma management should ultimately be defined by prospective, randomized trials.
authors.affiliation: From the Section of Trauma and Acute Care Surgery Department of Surgery, University of British Columbia, Vancouver, BC (Farquhar, Slobogean, Garraway, Simons, Hameed); Surgery Department, King Abdulaziz University, Jeddah, Saudi Arabia (Almahrabi); and the Division of Orthopedic Trauma Department of Orthopedics, University of British Columbia, Vancouver, BC (Slobogean).
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Farquhar
authors.affiliation: From the Section of Trauma and Acute Care Surgery Department of Surgery, University of British Columbia, Vancouver, BC (Farquhar, Slobogean, Garraway, Simons, Hameed); Surgery Department, King Abdulaziz University, Jeddah, Saudi Arabia (Almahrabi); and the Division of Orthopedic Trauma Department of Orthopedics, University of British Columbia, Vancouver, BC (Slobogean).
authors.forename: Yahya
authors.initials: Y
authors.lastname: Almarhabi
authors.affiliation: From the Section of Trauma and Acute Care Surgery Department of Surgery, University of British Columbia, Vancouver, BC (Farquhar, Slobogean, Garraway, Simons, Hameed); Surgery Department, King Abdulaziz University, Jeddah, Saudi Arabia (Almahrabi); and the Division of Orthopedic Trauma Department of Orthopedics, University of British Columbia, Vancouver, BC (Slobogean).
authors.forename: Gerard
authors.initials: G
authors.lastname: Slobogean
authors.affiliation: From the Section of Trauma and Acute Care Surgery Department of Surgery, University of British Columbia, Vancouver, BC (Farquhar, Slobogean, Garraway, Simons, Hameed); Surgery Department, King Abdulaziz University, Jeddah, Saudi Arabia (Almahrabi); and the Division of Orthopedic Trauma Department of Orthopedics, University of British Columbia, Vancouver, BC (Slobogean).
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Slobogean
authors.affiliation: From the Section of Trauma and Acute Care Surgery Department of Surgery, University of British Columbia, Vancouver, BC (Farquhar, Slobogean, Garraway, Simons, Hameed); Surgery Department, King Abdulaziz University, Jeddah, Saudi Arabia (Almahrabi); and the Division of Orthopedic Trauma Department of Orthopedics, University of British Columbia, Vancouver, BC (Slobogean).
authors.forename: Naisan
authors.initials: N
authors.lastname: Garraway
authors.affiliation: From the Section of Trauma and Acute Care Surgery Department of Surgery, University of British Columbia, Vancouver, BC (Farquhar, Slobogean, Garraway, Simons, Hameed); Surgery Department, King Abdulaziz University, Jeddah, Saudi Arabia (Almahrabi); and the Division of Orthopedic Trauma Department of Orthopedics, University of British Columbia, Vancouver, BC (Slobogean).
authors.forename: Richard K
authors.initials: RK
authors.lastname: Simons
authors.affiliation: From the Section of Trauma and Acute Care Surgery Department of Surgery, University of British Columbia, Vancouver, BC (Farquhar, Slobogean, Garraway, Simons, Hameed); Surgery Department, King Abdulaziz University, Jeddah, Saudi Arabia (Almahrabi); and the Division of Orthopedic Trauma Department of Orthopedics, University of British Columbia, Vancouver, BC (Slobogean).
authors.forename: S Morad
authors.initials: SM
authors.lastname: Hameed
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012253:Rib Fractures / Q000209:etiology / Q000601:surgery*; D013898:Thoracic Injuries / Q000150:complications