Surgical stabilization of traumatic flail chest

Abstract

Since 1970 the authors have stabilized the ribs to correct paradoxical movement of the chest wall in chest injuries, using an original technique, in order to avoid as far as possible the need for long term chest wall stabilization by intermittent positive pressure respiration (IPPR). The technical details of surgical stabilization are described, and the different types of stainless stell struts are shown. Type I was originally used either as an intramedullary nail or as an external brace. Types II and III were designed for external fixation of the strut to the rib. Treatment of 29 patients with severe flail chest, classified into four groups, is shown: group I was treated by IPPR, group II by IPPR plus surgical stabilization after exploratory thoracotomy. The clinical results are discussed. The authors conclude that surgical stabilization of the paradoxial movement of the chest wall can avoid the use of the respirator or at least reduce the interval of IPPR to a short period during the initial recovery from trauma. Using type III struts, the authors obtained stabilization of the flail chest in all cases even in patients with severe anterior paradoxical movement. The patients' tolerance of surgical stainless steel struts was good.