Journal of Clinical and Investigative Surgery
Felix Dobritoiu1, Mihai Dumitrescu2, Daniela Dobritoiu1
1Ponderas Academic Hospital, Department of Thoracic Surgery, Bucharest, Romania
2Marius Nasta Institute of Pneumology, Department of Thoracic Surgery, Bucharest, Romania
Introduction. Flail chest can become life-threatening when accompanied by other complications of thoracic trauma. Current hospital flail chest management includes mechanical ventilation and pain control. Although mechanical ventilation management is constantly improving, prolonged intubation and intensive care lead to increased morbidity. Surgical fixation is gaining more ground against non-operative care and authors have reported better outcome and fewer complications in restricted retrospective studies, but a consensus still has to be reached regarding the guidelines for surgical fixation. In this article, we wish to present our perspective on the surgical fixation of flail chest.
Materials and Method. A 39-year-old patient, known with chest trauma after a car accident for which he had undergone surgical treatment at another department, was admitted to our unit for chest instability and chronic pain. During the clinical examination of the left hemithorax, we noticed chest wall instability at the posterior arches of the 8th, 9th and 10th left ribs. CT scans of the thorax showed approximation of the ribs on the anterior fracture line and multiple displaced rib fractures, without callus formation, on the posterior fracture line.
Results. The 5th to 10th left ribs were cleared of fibrotic tissue, re-approximated and repositioned using matrix RIB titanium plates and screws. After surgery, the patient was kept in the intensive care unit for two days and was discharged after another seven days. Postoperative pain was managed with opioid therapy.
Conclusions. The debate regarding the operative management vs. the non-operative management of flail chest is ongoing given the relatively small number of patients included in the existing randomized-controlled trials. Osteosynthesis with plates and screws is easy to manage and we recommend the use of operative treatment of flail chest in patients who can withstand thoracic procedures.