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Erschienen in: European Journal of Trauma and Emergency Surgery 4/2014

01.08.2014 | Original Article

Surgical stabilization of flail chest: the impact on postoperative pulmonary function

verfasst von: S. M. Said, N. Goussous, M. D. Zielinski, H. J. Schiller, B. D. Kim

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 4/2014

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Abstract

Objectives

Flail chest results in significant morbidity. Controversies continue regarding the optimal management of flail chest. No clear guidelines exist for surgical stabilization. Our aim was to examine the association of bedside spirometry values with operative stabilization of flail chest.

Methods

IRB approval was obtained to identify patients with flail chest who underwent surgical stabilization between August 2009 and May 2011. At our institution, all rib fracture patients underwent routine measurement of their forced vital capacity (FVC) using bedside spirometry. Formal pulmonary function tests were also obtained postoperatively and at three months in patients undergoing stabilization. Both the Synthes and Acute Innovations plating systems were utilized. Data is presented as median (range) or (percentage).

Results

Twenty patients (13 male: 65 %) with median age of 60 years (30–83) had a median of four ribs (2–9) in the flail segment. The median Injury Severity Score was 17 (9–41) and the median Trauma and Injury Severity Score was 0.96 (0.04–0.99). Preoperative pneumonia was identified in four patients (20 %) and intubation was required in seven (35 %). Median time from injury to stabilization was four days (1–33). The median number of plates inserted was five (3–11). Postoperative median FVC (1.8 L, range 1.3–4 L) improved significantly as compared to preoperative median value (1 L, range 0.5–2.1 L) (p = 0.003). This improvement continued during the follow-up period at three months (0.9 L, range 0.1–3.0) (p = 0.006). There were three deaths (15 %), none of which were related to the procedure. Subsequent tracheostomy was required in three patients (15 %). The mean hospital stay and ventilator days after stabilization were nine days and three days, respectively. Mean follow-up was 5.6 ± 4.6 months.

Conclusion

Operative stabilization of flail chest improved pulmonary function compared with preoperative results. This improvement was sustained at three months follow-up.
Literatur
1.
Zurück zum Zitat Davignon K, Kwo J, Bigatello LM. Pathophysiology and management of the flail chest. Minerva Anestesiol. 2004;70:193–9. PubMed Davignon K, Kwo J, Bigatello LM. Pathophysiology and management of the flail chest. Minerva Anestesiol. 2004;70:193–9. PubMed
2.
Zurück zum Zitat Beg MH, Reyazuddin, Ansari MM. Conservative management of flail chest. J Indian Med Assoc. 1990;88:186–7. Beg MH, Reyazuddin, Ansari MM. Conservative management of flail chest. J Indian Med Assoc. 1990;88:186–7.
3.
Zurück zum Zitat Gaillard M, Herne C, Mandin, Raynaud P. Mortality prognosis factors in chest injury. J Trauma. 1990;30:93–6. Gaillard M, Herne C, Mandin, Raynaud P. Mortality prognosis factors in chest injury. J Trauma. 1990;30:93–6.
4.
Zurück zum Zitat Campbell DB. Trauma to the chest wall, lung, and major airways. Semin Thorac Cardiovasc Surg. 1992;4:234–40. PubMed Campbell DB. Trauma to the chest wall, lung, and major airways. Semin Thorac Cardiovasc Surg. 1992;4:234–40. PubMed
5.
Zurück zum Zitat Voggenreiter G, Neudeck F, Aufmkolk M, Obertacke U, Schmit-Neuerburg KP. Operative chest wall stabilization in flail chest: outcomes of patients with or without pulmonary contusion. J Am Coll Surg. 1998;187:130–8. PubMedCrossRef Voggenreiter G, Neudeck F, Aufmkolk M, Obertacke U, Schmit-Neuerburg KP. Operative chest wall stabilization in flail chest: outcomes of patients with or without pulmonary contusion. J Am Coll Surg. 1998;187:130–8. PubMedCrossRef
7.
Zurück zum Zitat Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma. 2002;52(4):727–32. PubMedCrossRef Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma. 2002;52(4):727–32. PubMedCrossRef
8.
Zurück zum Zitat Avery AE, Morch ET, Benson DW. Critically crushed chest: a new method of treatment with continuous mechanical hyperventilation to produce alkalotic apnea and internal pneumatic stabilization. J Thorac Surg. 1956;32:291–308. PubMed Avery AE, Morch ET, Benson DW. Critically crushed chest: a new method of treatment with continuous mechanical hyperventilation to produce alkalotic apnea and internal pneumatic stabilization. J Thorac Surg. 1956;32:291–308. PubMed
9.
Zurück zum Zitat Chihara K, Hitomi S, Kobayashi J, Kawarasaki S. Preservation and improvement of chest wall function. Nippon Geka Gakkai Zasshi. 1991;92:1363–6. PubMed Chihara K, Hitomi S, Kobayashi J, Kawarasaki S. Preservation and improvement of chest wall function. Nippon Geka Gakkai Zasshi. 1991;92:1363–6. PubMed
10.
Zurück zum Zitat Fleming WH, Bowen JC. Early complications of long term respiratory support. J Thorac Cardiovasc Surg. 1972;64:729–38. PubMed Fleming WH, Bowen JC. Early complications of long term respiratory support. J Thorac Cardiovasc Surg. 1972;64:729–38. PubMed
11.
Zurück zum Zitat Graeber GM, Cohen DJ, Patrick DH, et al. Rib fracture healing in experimental flail chest. J Trauma. 1985;25:903–8. PubMedCrossRef Graeber GM, Cohen DJ, Patrick DH, et al. Rib fracture healing in experimental flail chest. J Trauma. 1985;25:903–8. PubMedCrossRef
12.
Zurück zum Zitat Landercasper J, Cogbill TH, Lindesmith LA. Long-term disability after flail chest injury. J Trauma. 1984;24:410–4. PubMedCrossRef Landercasper J, Cogbill TH, Lindesmith LA. Long-term disability after flail chest injury. J Trauma. 1984;24:410–4. PubMedCrossRef
13.
Zurück zum Zitat Zahoor A, Zahoor M. Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation. J Thorac Cardiovasc Surg. 1995;110:1676–80. CrossRef Zahoor A, Zahoor M. Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation. J Thorac Cardiovasc Surg. 1995;110:1676–80. CrossRef
14.
Zurück zum Zitat Moore P. Operative stabilization of non-penetrating chest injuries. J Thorac Cardiovasc Surg. 1975;70:619–30. PubMed Moore P. Operative stabilization of non-penetrating chest injuries. J Thorac Cardiovasc Surg. 1975;70:619–30. PubMed
15.
Zurück zum Zitat Thomas AN, Blaisdell FW, Lewis FR, Schlobohm RM. Operative stabilization for flail chest after blunt trauma. J Thorac Cardiovasc Surg. 1978;70:619–26. Thomas AN, Blaisdell FW, Lewis FR, Schlobohm RM. Operative stabilization for flail chest after blunt trauma. J Thorac Cardiovasc Surg. 1978;70:619–26.
16.
Zurück zum Zitat Crutcher RR, Nolen TM. Multiple rib fracture with instability of chest wall. J Thorac Surg. 1956;32:15–21. PubMed Crutcher RR, Nolen TM. Multiple rib fracture with instability of chest wall. J Thorac Surg. 1956;32:15–21. PubMed
17.
Zurück zum Zitat Bottlang M, Helzel I, Long WB, Madey S. Anatomically contoured plates for fixation of rib fractures. J Trauma. 2010;68(3):611–5. PubMedCrossRef Bottlang M, Helzel I, Long WB, Madey S. Anatomically contoured plates for fixation of rib fractures. J Trauma. 2010;68(3):611–5. PubMedCrossRef
18.
Zurück zum Zitat Fitzpatrick DC, Denard PJ, Phelan D, et al. Operative stabilization of flail chest injuries: review of literature and fixation options. Eur J Trauma Emerg Surg. 2010;36(5):427–33. PubMedCentralPubMedCrossRef Fitzpatrick DC, Denard PJ, Phelan D, et al. Operative stabilization of flail chest injuries: review of literature and fixation options. Eur J Trauma Emerg Surg. 2010;36(5):427–33. PubMedCentralPubMedCrossRef
19.
Zurück zum Zitat Granetzny A, Abd M, Emam E, et al. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact Cardiovasc Thorac Surg. 2005;4(6):583–7. PubMedCrossRef Granetzny A, Abd M, Emam E, et al. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact Cardiovasc Thorac Surg. 2005;4(6):583–7. PubMedCrossRef
20.
Zurück zum Zitat Slobogean GP, MacPherson CA, Sun T, Pelletier ME, Hameed SM. Surgical fixation vs nonoperative management of flail chest: a meta-analysis. J Am Coll Surg. 2013;216(2):302–11. PubMedCrossRef Slobogean GP, MacPherson CA, Sun T, Pelletier ME, Hameed SM. Surgical fixation vs nonoperative management of flail chest: a meta-analysis. J Am Coll Surg. 2013;216(2):302–11. PubMedCrossRef
21.
Zurück zum Zitat Bhatnagar A, Mayberry J, Nirula R. Rib fracture fixation for flail chest: what is the benefit? J Am Coll Surg. 2012;215(2):201–5. PubMedCrossRef Bhatnagar A, Mayberry J, Nirula R. Rib fracture fixation for flail chest: what is the benefit? J Am Coll Surg. 2012;215(2):201–5. PubMedCrossRef
22.
Zurück zum Zitat Lardinois D, Krueger T, Dusmet M, et al. Pulmonary function testing after operative stabilization of the chest wall for flail chest. Eur J Cardiothorac Surg. 2001;20(3):496–501. PubMedCrossRef Lardinois D, Krueger T, Dusmet M, et al. Pulmonary function testing after operative stabilization of the chest wall for flail chest. Eur J Cardiothorac Surg. 2001;20(3):496–501. PubMedCrossRef
Metadaten
Titel
Surgical stabilization of flail chest: the impact on postoperative pulmonary function
verfasst von
S. M. Said
N. Goussous
M. D. Zielinski
H. J. Schiller
B. D. Kim
Publikationsdatum
01.08.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 4/2014
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-013-0344-9

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