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Open Fixation in Flail Chest: Review of 64 Patients

Akin Eraslan Balci, MD, evval Eren, MD, Ömer Çakir, MD, M Nesimi Eren, MD

Division of Thoracic and Cardiovascular Surgery, Dicle and Firat University School of Medicine, Diyarbakir, Turkey

For reprint information contact: Akin Eraslan Balci, MD Tel: 90 424 238 8080 Fax: 90 424 233 5038 Email: abalci{at}firat.edu.tr Division of Thoracic Surgery, Firat University School of Medicine, 23100 Elazi, Turkey.

The strategy for treatment of flail chest remains controversial. Various alternatives were assessed by reviewing the records of 64 patients treated from 1991 through 2000. Patients were classified according to therapeutic approach: group 1 was 27 patients who underwent open fixation of the fractured ribs, group 2 was 19 patients managed by intermittent positive-pressure ventilation, and group 3 was 18 patients managed mainly by synchronized intermittent mandatory ventilation. Two patients initially treated by ventilation underwent successful open fixation. In group 1, ventilatory support was required in 21 (77.8%) patients postoperatively, the mean duration of ventilation was 3.1 days, mean hospital stay was 18.3 days, morbidity was 11.1% (3/27), and mortality was 11.1%. In groups 2 and 3, the mean time for stabilization of paradoxical chest wall movement was 6.6 days, and mean duration of ventilation was 7.2 days. Mortality was 27.0% (10/37) in patients treated nonsurgically; 21.0% (4/19) in group 2, and 33.3% (6/18) in group 3. In groups 2 and 3, pain control required epidural analgesia in 13 (35.1%) cases, intercostal nerve blockade in 16 (43.2%), and narcotic or nonnarcotic parenteral analgesia in 8 (21.6%). Open fixation is a successful treatment modality for traumatic flail chest.

This article has been cited by other articles:

				J B Borman, L Aharonson-Daniel, B Savitsky, K Peleg, and the Israeli Trauma Group Unilateral flail chest is seldom a lethal injury Emerg. Med. J., December 1, 2006; 23(12): 903 - 905. [Abstract] [Full Text] [PDF]