gms | German Medical Science

Background: Selected patients with severe antero-lateral flail chest and impaired respiratory function who should recover quickly have an indication for operative stabilisation of the ribs. This is a prospective study of chest wall integrity and pulmonary function in these patients who underwent chest wall stabilisation with a new screwless fixation device (STRATOS^TM, MedXpert, Germany).

Methods: Between May 2008 and December 2009 14 patients (10 m, 4 w) with a mean age of 57 years (43–74) were operated for traumatic flail chest. The mean number of affected ribs was 8 (3–12), the sternum was fractured in 4 cases. Titanium rib clamps were placed and fixed to the stable parts of the most affected ribs and connected by titanium plates. Clinical outcome, pulmonary testing and dynamic assessment of the chest wall mobility by cine MRI were performed 6 months following surgery.

Results: 9 patients (64%) had various combinations of injuries of the thorax, head, abdomen and extremities. 9 patients (64%) underwent unilateral, 5 patients (35%) bilateral stabilisation with a medium delay of 5.4 days (1–14) from admission. 30 day mortality was 0%. Immediate postoperative extubation was feasible in 5 patients (35%). No material dislocation was observed during follow up. Two patients were reoperated due to infection and hematoma. After operation patients remained in hospital for 24.3 days in the mean (8–71), patients with monotrauma only 11.5 days. At 6 months preliminary data show no restriction in the pulmonary function testing and cineMRI shows symmetric movement of the chest wall. Time to return to normal daily activity was 44 days after discharge. Shoulder function was impaired after 6 months in 4 patients.

Conclusions: Our results suggest that antero-lateral flail chest injuries accompanied by respiratory insufficiency can be effectively stabilised by screwless titanium fixation device.

Disclosure: No significant relationships.