Objective: Thoracic trauma may be a life-threatening condition.
Flail chest is a severe chest injury with high mortality rates. Surgery is not frequently performed and, in Literature, data are controversial. The authors report their experience in the treatment of flail chest by an extracortical internal-external stabilization technique with Kirshner’s wires (K-wires). Methods: From ۲۰۱۰ to ۲۰۱۵, ۱۳۷ trauma patients (۱۰۹ males and ۲۸ females) with an average age of ۵۸.۸۹ ±۱۹.۷۴ years were observed. Seventeen (۱۲.۴۱%) patients presented a flail chest and of these, ۱۳ (۹.۴۹%) with an anterior one. All flail chest patients underwent early chest wall surgical stabilization (within ۴۸ hours from the injury). Results: In the general population, an overall morbidity of ۲۱.۹% (n = ۳۰ of ۱۳۷) and a ۳۰-day mortality rate of ۵.۱% (n = ۷ of ۱۳۷) were observed. By clustering the population according to the treatment (medical or interventional vs surgical), significant statistically differences between the two cohorts were found in morbidity (۱۲.۶۵% vs. ۳۴.۴۸%, P = ۰.۰۰۲) and mortality rates (۱.۲۸% vs. ۱۰.۳۴%, P = ۰.۰۱۷). In patients undergoing chest wall surgical stabilization, with an average Injury Severity Score of ۲۸.۳ ± ۵.۲ and
Abbreviated Injury Score (AIS) of ۸.۴ ± ۱.۷, an overall morbidity rate of ۵۲.۹% (n = ۹) and a mortality rate of ۱۷.۶% (n = ۳) were found. Post-surgical device removal, in local anesthesia or mild sedation, was performed ۴۲.۸ ± ۲.۹ days after chest wall stabilization and no cases of wound infection, dislodgment of the wires or osteosynthesis failure were reported. Moreover, in these patients, an early postoperative improvement in pulmonary ventilation (ΔpaO۲ and ΔpCO۲: +۹.۴۹ and -۵.۰۵, respectively) was reported. Conclusion: Surgical indication for the treatment of flail chest remains controversial and debated both due to an inadequate training and the absence of comparative prospective studies between various strategies. Our technique for the surgical treatment of the anterior flail chest seems to be anachronistic, but the aspects described, both in terms of technical features and of outcome and benefits (health, economic), allow to evaluate the effectiveness of this approach.
