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



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).


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.


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.


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.


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.



Complete flail chest stabilization


Diffusing capacity of lung for carbon monoxide


Forced expiratory volume in the first second of expiration


Forced vital capacity


Length of stay


Partial flail chest stabilization


Total lung capacity


Compliance with ethical standards

Conflict of interest



  1. 1.
    Karmy-Jones R, Jurkovich GJ (2004) Blunt chest trauma. Curr Probl Surg 41:211–380PubMedCrossRefGoogle Scholar
  2. 2.
    Mayberry JC, Trunkey DD (1997) The fractured rib in chest wall trauma. Chest Surg Clin N Am 7:239–261PubMedGoogle Scholar
  3. 3.
    Lafferty PM, Anavian J, Will RE, Cole PA (2011) Operative treatment of chest wall injuries: indications, technique, and outcomes. J Bone Joint Surg Am 93:97–110PubMedCrossRefGoogle Scholar
  4. 4.
    Ciraulo DL, Elliott D, Mitchell KA et al (1994) Flail chest as a marker for significant injuries. J Am Coll Surg 178:466–470PubMedGoogle Scholar
  5. 5.
    Marasco SF, Davies AR, Cooper J et al (2013) Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg 216:924–932PubMedCrossRefGoogle Scholar
  6. 6.
    Slobogean GP, MacPherson CA, Sun T et al (2013) Surgical fixation versus nonoperative management of flail chest: a meta-analysis. J Am Coll Surg 216:302–311PubMedCrossRefGoogle Scholar
  7. 7.
    Tanaka H, Yukioka T, Yamaguti Y et al (2002) Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma 52:727–732PubMedCrossRefGoogle Scholar
  8. 8.
    de Moya M, Bramos T, Agarwal S et al (2011) Pain as an indication for rib fixation: a bi-institutional pilot study. J Trauma 71:1750–1754PubMedCrossRefGoogle Scholar
  9. 9.
    Mouton W, Lardinois D, Furrer M et al (1997) Long-term follow-up of patients with operative stabilisation of a flail chest. Thorac Cardiovasc Surg 45:242–244PubMedCrossRefGoogle Scholar
  10. 10.
    Simon B, Ebert J, Bokhari F, Eastern Association for the Surgery of Trauma et al (2012) Management of pulmonary contusion and flail chest: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 73:S351–S361PubMedCrossRefGoogle Scholar
  11. 11.
    Fitzpatrick DC, Denard PJ, Phelan D et al (2010) Operative stabilization of flail chest injuries: review of literature and fixation options. Eur J Trauma Emerg Surg 36:427–433PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Bottlang M, Long WB, Phelan D et al (2013) Surgical stabilization of flail chest injuries with MatrixRIB implants: a prospective observational study. Injury 44:232–238PubMedCrossRefGoogle Scholar
  13. 13.
    Gasparri MG, Tisol WB, Haasler GB (2010) Rib stabilization: lessons learned. Eur J Trauma Emerg Surg 36:435–440CrossRefGoogle Scholar
  14. 14.
    Nickerson TP, Kim BD, Zielinski MD et al (2015) Use of a 90 drill and screwdriver for rib fracture stabilization. World J Surg 39:789–793. doi: 10.1007/s00268-014-2862-y PubMedCrossRefGoogle Scholar
  15. 15.
    Marasco S, Liew S, Edwards E et al (2014) Analysis of bone healing in flail chest injury: do we need to fix both fractures per rib? J Trauma Acute Care Surg 77:452–458PubMedCrossRefGoogle Scholar
  16. 16.
    Leinicke JA, Elmore L, Freeman BD et al (2013) Operative management of rib fractures in the setting of flail chest: a systematic review and meta-analysis. Ann Surg 258:914–921PubMedCrossRefGoogle Scholar

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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