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World Journal of Surgery

, Volume 40, Issue 1, pp 236–241 | Cite as

Outcomes of Complete Versus Partial Surgical Stabilization of Flail Chest

  • Terry P. Nickerson
  • Cornelius A. Thiels
  • Brian D. Kim
  • Martin D. Zielinski
  • Donald H. Jenkins
  • Henry J. Schiller
Original Scientific Report

Abstract

Background

Rib fractures are common after chest wall trauma. For patients with flail chest, surgical stabilization is a promising technique for reducing morbidity. Anatomical difficulties often lead to an inability to completely repair the flail chest; thus, the result is partial flail chest stabilization (PFS). We hypothesized that patients with PFS have outcomes similar to those undergoing complete flail chest stabilization (CFS).

Methods

A prospectively collected database of all patients who underwent rib fracture stabilization procedures from August 2009 until February 2013 was reviewed. Abstracted data included procedural and complication data, extent of stabilization, and pulmonary function test results.

Results

Of 43 patients who underwent operative stabilization of flail chest, 23 (53 %) had CFS and 20 (47 %) underwent PFS. Anterior location of the fracture was the most common reason for PFS (45 %). Age, sex, operative time, pneumonia, intensive care unit and hospital length of stay, and narcotic use were the same in both groups. Total lung capacity was significantly improved in the CFS group at 3 months. No chest wall deformity was appreciated on follow-up, and no patients underwent additional stabilization procedures following PFS.

Conclusion

Despite advances in surgical technique, not all fractures are amenable to repair. There was no difference in chest wall deformity, narcotic use, or clinically significant impairment in pulmonary function tests among patients who underwent PFS compared with CFS. Our data suggest that PFS is an acceptable strategy and that extending or creating additional incisions for CFS is unnecessary.

Keywords

Chest Wall Total Lung Capacity Flail Chest Additional Incision Chest Wall Deformity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

CFS

Complete flail chest stabilization

Dlco

Diffusing capacity of lung for carbon monoxide

FEV1

Forced expiratory volume in the first second of expiration

FVC

Forced vital capacity

LOS

Length of stay

PFS

Partial flail chest stabilization

TLC

Total lung capacity

Notes

Compliance with ethical standards

Conflict of interest

None.

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Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Terry P. Nickerson
    • 1
  • Cornelius A. Thiels
    • 1
  • Brian D. Kim
    • 1
  • Martin D. Zielinski
    • 1
  • Donald H. Jenkins
    • 1
  • Henry J. Schiller
    • 1
  1. 1.Department of SurgeryMayo ClinicRochesterUSA

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