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Comparison of Rib Fracture Location for Morbidity and Mortality in Flail Chest  

Byun, Chun Sung (Trauma Center, Yonsei University Wonju College of Medicine, Wouju Severance Christian Hospital)
Park, Il Hwan (Trauma Center, Yonsei University Wonju College of Medicine, Wouju Severance Christian Hospital)
Bae, Geum Suk (Trauma Center, Yonsei University Wonju College of Medicine, Wouju Severance Christian Hospital)
Jeong, Pil Yeong (Trauma Center, Yonsei University Wonju College of Medicine, Wouju Severance Christian Hospital)
Oh, Joong Hwan (Trauma Center, Yonsei University Wonju College of Medicine, Wouju Severance Christian Hospital)
Publication Information
Journal of Trauma and Injury / v.26, no.3, 2013 , pp. 170-174 More about this Journal
Abstract
Purpose: A flail chest is one of most challenging problems for trauma surgeons. It is usually accompanied by significant underlying pulmonary parenchymal injuries and mayled to a life-threatening thoracic injury. In this study, we evaluated the treatment result for a flail chest to determine the effect of trauma localization on morbidity and mortality. Methods: Between 2004 and 2011, 46 patients(29 males/17 females) were treated for a flail chest. The patients were divided into two group based on the location of the trauma in the chest wall; Group I contained patients with an anterior flail chest due to a bilateral costochondral separation (n=27) and Group II contained patients with a single-side posterolateral flail chest due to a segmental rib fracture (n=19). The location of the trauma in the chest wall, other injuries, mechanical ventilation support, prognosis and ISS (injury severity score) were retrospectively examined in the two groups. Results: Mechanical ventilation support was given in 38 patients(82.6%), and 7 of these 38 patients required a subsequent tracheostomy. The mean ISS for all 46 patients was $19.08{\pm}10.57$. Between the two groups, there was a significant difference in mean ventilator time (p<0.048), but no significant difference in either trauma-related morbidity (p=0.369) or mortality (p=0.189). Conclusion: An anterior flail chest frequently affects the two underlying lung parenchyma and can cause a bilateral lung contusion, a hemopneumothorax and lung hemorrhage. Thus, it needs longer ventilator care than a lateral flail chest does and is more frequently associated with pulmonary complications with poor outcome than a lateral flail chest is. In a severe trauma patient with a flail chest, especially an anterior flail chest, we must pay more attention to the pulmonary care strategy and the bronchial toilet.
Keywords
Trauma; Rib fracture; Flail chest;
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1 Lardinois D, Krueger T, Dusmet M, Ghisletta N, Gugger M, Ris HB. Pulmonary function testing after operative stabilization of the chest wall for flail chest. Eur J Cardiothorac Surg 2001; 20(3): 496-501.   DOI   ScienceOn
2 Mouton W, Lardinois D, Furrer M, Regli B, Ris HB. Longterm follow up of patients with operative stabilization of a flail chest. Thorac Cardiovasc Surg 1997; 45: 242-4.   DOI   ScienceOn
3 Tanaka H, Yukioka T, Yamaguti Y, Shimizu S, Goto H, Shimazaki S. Surgical stabilization or internal pneumatic stabilization? a prospective randomized study of management of severe flail chest patients. J Trauma 2002; 52(4): 727-32.   DOI   ScienceOn
4 Kishikawa M, Minami T, Shimazu T, Sugimoyo H, Yoshioka T, Katsurada K, et al. Laterality of air volume in the lungs long after chest trauma. J Trauma 1993; 34(6): 908-13.   DOI
5 Balci AE, Eren S, Cakir O, Eren MN. Open fixation in flail chest: review of 64 patients. Asian Cardiovasc thorac Ann 2004; 12: 11-5.   DOI   ScienceOn
6 Athanassiadi K, Gerazounis M, Theakos N. Management of 150 flail chest injuries: analysis of risk factors affecting outcome. Eur J Cardiothorac Surg 2004; 26: 373-6.   DOI   ScienceOn
7 Fitzpatrick DC, Denard PJ, Phelan D, Long WB, Madey SM, Bottlang M. Operative stabilization of flail chest injuries: review of literature and fixation options. Eur J Trauma Emerg Surg 2010; 36: 427-33.   DOI
8 Ali BA, Sanfilippo F. Management of flail chest in trauma: analysis of risk factors affecting outcomes. ANZ J Surg 2007; 77: A93.
9 Sirmali M, Turut H, Topcu S, Gulhan E, Yazici U, Kaya S, et al. A comprehensive analysis of traumatic rib fractures: morbidity, mortality, and management. Eur J Cardiothorac Surg 2003; 24: 133-8.   DOI   ScienceOn
10 Wanek S, Mayberry JC. Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury. Crit Care Clin 2004; 20: 71-81.   DOI   ScienceOn
11 Davignon K, Kwo J, Bigatello LM. Pathophysiology and management of the flail chest. Minerva Anesthesiol 2004; 70: 193-9.
12 Landerscaper J, Cogbill TH, Lindesmith LA. Long-term disability after flail chest injury. J Trauma 1984; 24: 410-4.   DOI
13 Pettiford BL, Luketich JD, Landreneau RJ. The Management of Flail Chest. Thorac Surg Clin 2007; 17: 25-33.   DOI   ScienceOn
14 Kilic D, Findikcioglu A, Akin S, Akay TH, Dupeli E, Aribogan A, et al. Factors Affecting Morbidity and Mortality in Flail Chest: Comparison of Anterior and Lateral Location. Thorac Cardiov Surg 2011; 59: 45-8.
15 Borman JB, Aharonson-Daniel L, Savitsky B, Peleg K. Unilateral flail chest is seldom a lethal injury. Emerg Med J 2006; 23: 903-5.   DOI   ScienceOn
16 Bastos R, Calhoon JH, Baisden CE. Flail chest and pulmonary contusion. Semin Thorac Cardiovasc Surg 2008; 20: 39-45.   DOI   ScienceOn
17 Ahmed Z, Mohyuddin Z. Management of Flail Chest injury: internal fixation versus endotracheal intubation. J Thorac Cardiovasc Surg 1995; 110: 1676-80.   DOI   ScienceOn
18 Leo F, Venissac N, Lopez S, Pop D, Savinelli F, Mouroux J. Anterior flail chest and sternal fracture: to fix or not to fix? Asian Cardiovasc Thorac Ann 2003; 11: 188.   DOI   ScienceOn
19 Trunkey DD. Trauma. Accidental and intentional injuries account for more years of life lost in the U.S. than cancer and heart disease. Among the prescribed remedies are improved preventive efforts, speedier surgery and further research. Sci Am 1983; 249: 28-35.   DOI   ScienceOn
20 Adegboye VO, Ladipo JK, Brimmo IA, Adebo AO. Blunt chest trauma. Afr J Med Med Sci 2002; 31: 315-20.
21 Liman ST, Kuzucu A, Tastepe AI, Ulasan GN, Topcu S. Chest injury due to blunt trauma. Eur J Cardiothorac Surg 2003; 23: 374-8.   DOI   ScienceOn
22 Beal SL, Oreskovich MR. Long-term disability associated with flail chest injury. Am J Surg 1985; 150: 324-6.   DOI   ScienceOn