Long-Term Outcome Following Flail Chest Injuries

Abstract

While prior studies have focused on the acute or short-term benefits of surgical intervention for flail chest injuries (i.e., decreased time of mechanical ventilation), it is important to remember that of equal or greater significance to the patient is their long-term outcome. A number of negative chronic sequelae have been described following crushing injuries to the chest. These include chronic chest wall pain and deformity, dyspnea, abnormal pulmonary dysfunction, and impaired general health status. Two separate studies have reported that fewer than half of patients with flail chest injuries treated nonoperatively have been able to return to gainful employment. There is obviously room for improvement in this area: to do so, the rate and severity of long-term complications need to be carefully defined so that the results of intervention (i.e., surgical stabilization) can be properly analyzed. While it is reasonable to postulate that surgery may improve certain aspects of these injuries (such as chest wall deformity), higher-level prospective, comparative, or randomized trials, with long-term follow-up, are required for definitive information on this topic. Additionally, certain concomitant injuries (such as a pulmonary contusion or head injury) can have a major effect on outcome. This chapter will discuss the most up-to-date information available on this topic of long-term outcome following a flail chest injury.