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      A Case of Traumatic Flail Chest Requiring Stabilization with Surgical Reconstruction

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          Abstract

          Background Flail chest is the most serious complication that may occur after thoracic trauma. In this article, we present a case of flail chest caused by blunt chest trauma, which presented dramatic clinical improvement following rib fixation and chest wall reconstruction.

          Case Description A 53-year-old male patient with flail chest because of the trauma who had been followed in intensive care unit for mechanical ventilatory support underwent chest wall stabilization with titanium reconstruction plate and screws.

          Conclusion The main objective is surgical stabilization of the chest wall in cases of flail chest with a parenchymal damage because of the severe rib fracture, which need prolonged mechanical ventilation.

          Most cited references5

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          Chest injury due to blunt trauma.

          Salih Topcu, Serife Liman, Akin Kuzucu … (2003)
          Given its importance in trauma practice, we aimed to determine the pathologies associated with blunt chest injuries and to analyze the accurate identification of patients at high risk for major chest trauma. We reviewed our experience with 1490 patients with blunt chest injuries who were admitted over a 2-year period. Patients were divided into three groups based on the presence of rib fractures. The groups were evaluated to demonstrate the relationship between the number of rib fractures and associated injuries. The possible effects of age and Injury Severity Score (ISS) on mortality were analyzed. Mean hospitalization time was 4.5 days. Mortality rate was 1% for the patients with blunt chest trauma, 4.7% in patients with more than two rib fractures and 17% for those with flail chest. There was significant association between the mortality rate and number of rib fractures, the patient's age and ISS. The rate of development of pneumothorax and/or hemothorax was 6.7% in patients with no rib fracture, 24.9% in patients with one or two rib fractures and 81.4% in patients with more than two rib fractures. The number of rib fractures was significantly related with the presence of hemothorax or pneumothorax. Achieving better results in the treatment of patients with chest wall injury depend on a variety of factors. The risk of mortality was associated with the presence of more than two rib fractures, with patients over the age of 60 years and with an ISS greater than or equal to 16 in chest trauma. Those patients at high risk for morbidity and mortality and the suitable approach methods for them should be acknowledged.
          Article 0 comments Cited 57 times – based on 0 reviews     Review now
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            Geometry of human ribs pertinent to orthopedic chest-wall reconstruction.

            Ron Abrams, Michael Bottlang, Ashley Mohr … (2006)
            Orthopedic reconstruction of blunt chest trauma can aid restoration of pulmonary function to reduce the mortality associated with serial rib fractures and flail chest injuries. Contemporary chest wall reconstruction requires contouring of generic plates to the complex surface geometry of ribs. This study established a biometric foundation to generate specialized, anatomically contoured osteosynthesis hardware for rib fracture fixation. On human cadaveric ribs three through nine, the surface geometry pertinent to anatomically conforming osteosynthesis plates was characterized by quantifying the apparent rib curvature C(A), the longitudinal twist alpha(LT) along the diaphysis, and the unrolled curvature C(U). In addition, the rib cross-sectional geometry pertinent to intramedullary fixation strategies was characterized in terms of cross-section height, width, area, and cortex thickness. The rib surface exhibited a curvature C(A) ranging from 3.8 m(-1) in the anteromedial section of rib seven to 17.3 m(-1) in the posterior section of rib three. All ribs had in common a longitudinal twist alpha(LT), ranging from 41-60 degrees. The unrolled curvature C(U) decreased gradually from ribs three to five, and increased gradually with reversed orientation from rib six to nine. The cross-sectional area remained constant along the rib diaphysis. However, the medullary canal increased in size from 29.9 mm(2) posteriorly to 41.2 mm(2) in anterior rib segments. Results of this biometric rib characterization describe a novel strategy for intraoperative plate contouring and provide a foundation for the development of specialized rib osteosynthesis strategies.
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              Operative chest wall fixation with osteosynthesis plates.

              Charles Engel, Russell Long, S. Madey … (2004)
              Article 0 comments Cited 11 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Thorac Cardiovasc Surg Rep
                Journal ID (iso-abbrev): Thorac Cardiovasc Surg Rep
                Journal ID (doi): 10.1055/s-00024355
                Title: The Thoracic and Cardiovascular Surgeon Reports
                Publisher: Georg Thieme Verlag KG (Stuttgart · New York )
                ISSN (Print): 2194-7635
                ISSN (Electronic): 2194-7643
                Publication date (Electronic): 20 August 2015
                Publication date (Print): December 2015
                Volume: 4
                Issue: 1
                Pages: 8-10
                Affiliations
                [1 ]Department of Thoracic Surgery, Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
                Author notes
                Address for correspondence Ilker Kolbas, MD Department of Thoracic Surgery Sureyyapasa Chest Disease and Thoracic Surgery Training and Research HospitalBasıbuyuk Mah. Maltepe, Istanbul 34844Turkey dr_ilkerkolbas@ 123456hotmail.com
                Article
                Publisher ID: 150176crt
                DOI: 10.1055/s-0035-1558433
                PMC ID: 4670308
                SO-VID: 424af0b2-a4ea-4fa5-97ae-455aeb54d665
                Copyright © © Thieme Medical Publishers
                History
                Date received : 22 May 2015
                Date accepted : 05 June 2015
                Categories
                Subject: Article

                Keywords: thoracic trauma,flail chest,chest wall stabilization
                Data availability:
                Keywords: thoracic trauma, flail chest, chest wall stabilization

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