Flail chest injury—changing management and outcomes

Silvana F. Marasco, Jacqueline Nguyen Khuong, Mark Fitzgerald, Robyn Summerhayes, Mir Wais Sekandarzad, Vincent Varley, Ryan J. Campbell, Michael Bailey

Research output: Contribution to journalArticleResearchpeer-review

4 Citations (Scopus)


Purpose: The purpose of this study was to assess trends in management of flail chest injuries over time and to determine impact on patient outcomes. Methods: A retrospective review of data from a prospectively collated database of all trauma patients admitted to a level 1 trauma service in Victoria was conducted. All trauma patients admitted to the hospital between July 2008 and June 2020 with an Abbreviated Injury Scale (AIS) code for flail chest injury were included. Results: Our study included 720 patients, mean age was 59.5 ± 17.3 years old, and 76.5% of patients were male. Length of ICU stay decreased on average by 9 h each year. Regional anaesthesia use increased by 15% per year (0% in 2009 to 36% in 2020) (p < 0.001). Surgical stabilisation of rib fractures increased by 16% per year (2.9% in 2009 to 22.3% in 2020) (p = 0.006). The use of invasive ventilation decreased by 14% per year (70% in 2008 to 27% in 2020) (p < 0.001), and invasive ventilation time decreased by 8 h per year (p = 0.007). Conclusion: Over the past decade, we have seen increasing rates of regional anaesthesia and surgical rib fixation in the management of flail chest. This has resulted in lower requirements for and duration of invasive mechanical ventilation and intensive care unit stay but has not impacted mortality in this patient cohort.

Original languageEnglish
Pages (from-to)1047-1055
Number of pages9
JournalEuropean Journal of Trauma and Emergency Surgery
Issue number2
Publication statusPublished - Apr 2023


  • Chest wall injury
  • Flail chest
  • Rib fixation
  • Rib fracture

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