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      Stabilization of Flail Chest and Fractured Sternum by Minimally Invasive Repair of Pectus Excavatum

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          Abstract

          We report a 55-year-old male patient with a massive flail chest that required chest stabilization by minimally invasive repair of pectus excavatum (MIRPE) employing a Nuss bar. Surgical stabilization of severe flail chest and fractured sternum with Nuss bar by MIRPE is a safe and useful treatment modality in properly selected patients.

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          Operative stabilization of flail chest injuries: review of literature and fixation options

          D Fitzpatrick, P Denard, P Phelan … (2010)
          Background Flail chest injuries cause significant morbidity, especially in multiply injured patients. Standard treatment is typically focused on the underlying lung injury and involves pain control and positive pressure ventilation. Several studies suggest improved short- and long-term outcomes following operative stabilization of the flail segments. Despite these studies, flail chest fixation remains a largely underutilized procedure. Methods This article reviews the relevant literature concerning flail chest fixation and describes the different implants and techniques available for fixation. Additionally, an illustrative case example is provided for description of the surgical approach. Results Two prospective randomized studies, five comparative studies, and a number of case series documented benefits of operative treatment of flail chest injuries, including a decreased in ventilation duration, ICU stay, rates of pneumonia, mortality, residual chest wall deformity, and total cost of care. Historically, rib fractures have been stabilized with external plates or intramedullary implants. The use of contemporary, anatomically contoured rib plates reduced the need for intraoperative plate bending. Intramedullary rib splints allowed less-invasive fixation of posterior fractures where access for plating was limited. Conclusion Operative treatment can provide substantial benefits to patients with flail chest injuries and respiratory compromise requiring mechanical ventilation. The use of anatomically contoured rib plates and intramedullary splints greatly simplifies the procedure of flail chest fixation.
          Article 0 comments Cited 18 times – based on 0 reviews     Review now
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            Clinical management of blunt trauma patients with unilateral rib fractures: a randomized trial.

            Sheryl S G Gabram, R J Schwartz, L M Jacobs … (2015)
            Optimal pain management is essential in blunt trauma patients sustaining significant chest trauma. The purpose of this randomized prospective trial was to measure the difference in pulmonary function in nonintubated patients with unilateral multiple rib fractures receiving two modalities of pain relief: systemic narcotic medications alone or local anesthetics given by intrapleural catheter (IPCs). Forty-two patients were randomized to receive systemic narcotic medications or IPCs for pain control. The patients with IPCs statistically had more compromised pulmonary function as measured by forced vital capacity (FVC) on admission; however, they tended toward a greater objective improvement of FVC on discharge. When analyzing a cohort of severely impaired patients (initial FVC < 20%), half of the systemic medication patients compared to only 10% of the IPC group failed and required another mode of therapy. Catheter complications were minor and did not contribute to overall morbidity. The IPC patients had fewer failures than the systemic medication patients.
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              Flail chest stabilization with Nuss operation in presence of multiple myeloma.

              Song Am Lee, Jae Joon Hwang, Hyun Chee … (2014)
              Nowadays the Nuss operation has been widely adopted as a minimally invasive procedure and standard surgical choice in pectus excavatum. However, much debate and concern have been raised regarding its applicability in adults with pectus excavatum flail chest and other thoratic wall deformities, as compared with younger patients, in terms of complications after surgery. To stabilize the segment of paradoxical chest wall movement we performed the Nuss operation on a patient with multiple myeloma who sustained blunt thoracic trauma. The patient presented with paradoxical movement of the thoracic wall and sternum instability due to multiple myeloma, which led to severe dyspnea, hypoxemia, hypercapnea, and bedridden state. His condition progressed to acute respiratory distress syndrome and did not respond to conservative treatment. We performed the Nuss operation on the patient, and his clinical symptoms were relieved after surgery. The patient regained the ability to walk unassisted and was discharged from the hospital without any specific events.
              Article 0 comments Cited 4 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: 11-13
                Affiliations
                [1 ]Department of Thoracic Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
                [2 ]Department of Pulmonology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
                [3 ]Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
                Author notes
                Address for correspondence Mehmet Kaya, MD Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Mehmet Akif Ersoy GKDC Eğitim Hastanesi Halkali Küçükçekmece, Istanbul 34000Turkey drmehmetkaya@ 123456yahoo.com
                Article
                Publisher ID: 150167crt
                DOI: 10.1055/s-0035-1563399
                PMC ID: 4670315
                SO-VID: 6c50bcf7-a642-4c8b-8def-6abeb68a4260
                Copyright © © Thieme Medical Publishers
                History
                Date received : 30 April 2015
                Date accepted : 26 June 2015
                Categories
                Subject: Article

                Keywords: flail chest,nuss bar,sternal fracture
                Data availability:
                Keywords: flail chest, nuss bar, sternal fracture

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