Prospective randomized controlled trial of operative rib fixation in traumatic flail chest.

Abstract

BACKGROUND:

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.

STUDY DESIGN:

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.

RESULTS:

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.

CONCLUSIONS:

Operative fixation of fractured ribs reduces ventilation requirement and intensive care stay in a cohort of multitrauma patients with severe flail chest injury.

• Authors: Silvana F Marasco, Andrew R Davies, Jamie Cooper, Dinesh Varma, Victoria Bennett, Rachael Nevill, Geraldine Lee, Michael Bailey, Mark Fitzgerald
• Journal: Journal of the American College of Surgeons (J Am Coll Surg) Vol. 216 Issue 5 Pg. 924-32 (May 2013) ISSN: 1879-1190 [Electronic] United States
• PMID: 23415550 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Female
• Flail Chest (diagnostic imaging, etiology, surgery, therapy)
• Follow-Up Studies
• Fracture Fixation, Internal (methods)
• Humans
• Imaging, Three-Dimensional
• Intensive Care Units
• Length of Stay
• Male
• Middle Aged
• Noninvasive Ventilation
• Odds Ratio
• Prospective Studies
• Quality of Life
• Rib Fractures (diagnostic imaging, etiology, surgery, therapy)
• Spirometry
• Surveys and Questionnaires
• Thoracic Injuries (complications, therapy)
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome