Surgical treatment of patients with multiple rib fractures and flail chest

Introduction. Chest injuries are top third by incidence among body injuries and second top among causes of death in trauma patients. Over the last two decades, a few publications by foreign and Russian investigators have studied the advantages of early surgical rib cage stabilization over conservative treatment. However, by now the efficacy of active surgical strategy has not been convincingly proven in multiple rib fractures, including the use of standard plate osteosynthesis for small segments, as well as absorbable pins.

The study objective is to present early results of surgical treatment of multiple rib fractures and rib valve using standard 1/3 tubular and reconstruction plates and absorbable pins in level 1 and 2 trauma centers without a referral thoracic surgery department.

Methods. The study included 26 patients who underwent surgical rib cage stabilization for multiple rib fractures and/or flail chest in 2018–2023. Those included 15 patients with polytrauma (ISS over 17 points), 5 patients with combined trauma (ISS under 17 points), and 6 patients with isolated chest trauma. One-stage fixation of 1 to 5 ribs was performed.

Results and analysis. The overall median of hospital stay was 16.5 (min. 6 to max 50) days, ICU stay was 3 (0 to 25) days, days of ventilation support was 0 (0 to 18) days, and need for oxygen support was 0 (0 to 16) days. The mean pleural cavity drain duration was (8.1 ± 3.8) days. Respiratory complications were observed in 11 % of cases. In 8 % of cases tracheostomy was required.

Discussion. Active surgical strategy with rib osteosynthesis allows to quickly and effectively stabilize the condition of patients with severe thoracic trauma. Standard osteosynthesis plates for small segments with angular stability screws allow to achieve fixation stability of damaged ribs, contributing to the restoration of normal chest excursion, better pain syndrome control and prevention of complications. More profound studies of conventional osteosynthesis and various subtypes are required in the future to compare between the results of different osteosynthesis methods, on the one hand, and the results of surgical and conservative treatment, on the other hand.

Conclusion. Absorbable pins and standard osteosynthesis plates (rather than special ones) in rib fractures enable quick stabilization of patients with severe chest injury.

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