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

Silvana Marasco, Andrew Davies, David James Cooper, Dinesh Kumar Varma, Victoria Bennett, Geraldine Anne Lee, Mark Fitzgerald, Michael John Bailey

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201 Citations (Scopus)

Abstract

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. (J Am Coll Surg 2013;-:1e9. 2013 by the American College of Surgeons)
Original languageEnglish
Pages (from-to)924 - 932
Number of pages9
JournalJournal of the American College of Surgeons
Volume216
Issue number5
DOIs
Publication statusPublished - 2013

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