Surgical and perioperative management of flail chest with titanium plates: a French cohort series from a thoracic referral center.

Abstract

BACKGROUND:

The development of titanium claw plates has made rib osteosynthesis easy to achieve and led to a renewed interest for this surgery. We report the management of patients referred to the intensive care unit (ICU) of a referral center for surgical rib fracture fixation (SRFF) after chest trauma.

METHODS:

We performed a retrospective observational cohort study describing the patients' characteristics and analyzing the determinants of postoperative complications.

RESULTS:

From November 2013 to December 2016, 42 patients were referred to our center for SRFF: 12 patients (29%) had acute respiratory failure, 6 of whom received invasive mechanical ventilation. The Thoracic Trauma Severity Score (TTSS) was 11.0 [9-12], with 7 [5-9] broken ribs and a flail chest in 92% of cases. A postoperative complication occurred in 18 patients (43%). Five patients developed ARDS (12%). Postoperative pneumonia occurred in 11 patients (26%). Two patients died in the ICU. In multivariable analysis, the Thoracic Trauma Severity Score (TTSS) (OR = 1.89; CI 95% 1.12-3.17; p = 0.016) and the Simplified Acute Physiology Score II without age (OR = 1.17; CI 95% 1.02-1.34; p = 0.024) were independently associated with the occurrence of a postoperative complication.

CONCLUSION:

The TTSS score appears to be accurate for determining thoracic trauma severity. Short and long-term benefit of Surgical Rib Fracture Fixation should be assessed, particularly in non-mechanically ventilated patients.

• Authors: Sarah Féray, Clarisse Blayau, Hicham Masmoudi, Samuel Haddad, Christophe Quesnel, Jalal Assouad, Muriel Fartoukh
• Journal: Journal of cardiothoracic surgery (J Cardiothorac Surg) Vol. 18 Issue 1 Pg. 37 (Jan 18 2023) ISSN: 1749-8090 [Electronic] England
• PMID: 36653803 (Publication Type: Observational Study, Journal Article)
• Copyright: © 2023. The Author(s).

Chemical References

• Titanium

Topics

• Humans
• Flail Chest (surgery)
• Titanium
• Retrospective Studies
• Rib Fractures (surgery, complications)
• Thoracic Injuries (complications)
• Fracture Fixation, Internal (adverse effects)
• Postoperative Complications