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      External flail chest stabilization; The simple, low-cost way

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          Abstract

          Flail chest is a life-threatening clinical entity which can be complicated by respiratory insufficiency. Paradoxical motion of a part of chest wall is the basic cause to put the blame on. Consequently, stabilization of the chest wall is occasionally of paramount importance to achieve early extubation in a patient with post-trauma respiratory insufficiency. Hereby, a simple, low cost, harmless and effective approach of external stabilization is presented.

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          Flail chest injuries: a review of outcomes and treatment practices from the National Trauma Data Bank.

          Flail chest injuries are associated with severe pulmonary restriction, a requirement for intubation and mechanical ventilation, and high rates of morbidity and mortality. Our goals were to investigate the prevalence, current treatment practices, and outcomes of flail chest injuries in polytrauma patients.
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            Prospective randomized controlled trial of operative rib fixation in traumatic flail chest.

            Traumatic flail chest injury is a potentially life threatening condition traditionally treated with invasive mechanical ventilation to splint the chest wall. Longer-term sequelae of pain, deformity, and physical restriction are well described. This study investigated the impact of operative fixation in these patients. A prospective randomized study compared operative fixation of fractured ribs in the flail segment with current best practice mechanical ventilator management. In-hospital data, 3-month follow-up review, spirometry and CT, and 6-month quality of life (Short Form-36) questionnaire were collected. Patients in the operative fixation group had significantly shorter ICU stay (hours) postrandomization (285 hours [range 191 to 319 hours] for the surgical group vs 359 hours [range 270 to 581 hours] for the conservative group; p = 0.03) and lesser requirement for noninvasive ventilation after extubation (3 hours [range 0 to 25 hours] in the surgical group vs 50 hours [range 17 to 102 hours] in the conservative group; p = 0.01). No differences in spirometry at 3 months or quality of life at 6 months were noted. Operative fixation of fractured ribs reduces ventilation requirement and intensive care stay in a cohort of multitrauma patients with severe flail chest injury. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.
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              Operative stabilization of flail chest injuries: review of literature and fixation options

              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.
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                Author and article information

                Journal
                J Cardiovasc Thorac Res
                J Cardiovasc Thorac Res
                J Cardiovasc Thorac Res
                JCVTR
                TBZMED
                Journal of Cardiovascular and Thoracic Research
                Tabriz University of Medical Sciences
                2008-5117
                2008-6830
                2021
                28 November 2020
                : 13
                : 2
                : 174-175
                Affiliations
                1Cardiothoracic Surgery Department, University Hospital of Ioannina, School of Medicine, Ioannina, Greece
                2Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece
                Author notes
                [* ]Corresponding Author: Nikolaos A. Papakonstantinou, Email: nikppk@ 123456yahoo.gr
                Author information
                https://orcid.org/0000-0002-1272-7990
                Article
                10.34172/jcvtr.2020.58
                8302900
                34326973
                8c0fbe65-b63c-41f8-ba49-2b710766e1d3
                © 2021 The Author(s)

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 January 2020
                : 30 September 2020
                Page count
                Figures: 2, References: 5, Pages: 2
                Categories
                Case Report

                thoracic trauma,flail chest,external stabilization,respiratory insufficiency

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