>Year 2017, Issue 4
Luna-Tovar A, Rodríguez LMR, Morales VR, Noriega UVM
Surgical treatment of the unstable thorax. Where do we stand? A private hospital experience
Cir Gen 2017; 39 (4)
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Introduction: Thoracic trauma has serious implications, accounting for 20% of all trauma deaths. Flail chest resulting from multiple rib fractures aggravates the problem and is responsible for significant morbidity and mortality. Initially, these patients were treated with pain management, and internal pneumatic stabilization when needed. In 1998, Tanaka and his group were the first to evaluate the differences between this management and surgical management with open reduction and internal fixation; since then, evidence has shown better outcomes with the surgical treatment, with a shorter hospital length of stay, less length of stay in the ICU with mechanical ventilation and better results. In 2001, our surgical team began the use of surgical rib fixation in patients with flail chest. Material and methods: This article evaluates the different surgical options for open reduction-internal fixation (ORIF) throughout time. We present 11 cases with a flail chest diagnosis that had surgical management. Initially, we used wire sutures for approximation and surgical fixation, osteosyntheses with maxillofacial devices and, lately, titanium devices such as StraCos®. Results: During the past 16 years, ten patients presented to our hospital with closed thoracic trauma and one with penetrating trauma. The patients had a mean ISS of 30.2 (SD = 14.39). The mean hospital length of stay was 21.8 days (SD = 11.14). The mean of days in the intensive care unit (DICU) was 8.9 days (SD = 4.89). The number of rib fractures with internal fixation (NRFIF) and DICU showed an important negative correlation, r (12) = -0.624, p = 0.039. In turn, NRF and the days in mechanical ventilation (DMV) also showed an important negative correlation, r (12) = -0.698, p = 0.015, with the NRFIF explaining 48.7% of the variation found in the DMV. A single sample t test was performed, analyzing our DMV values (m = 6.45, SD = 4.61) against those reported in the literature, without finding significant difference, t (10) = 1.837, p = 0.096. The number of rib fractures treated with surgical fixation in patients was associated with a shorter stay in intensive care and less days of mechanical ventilation. This decrease was not found related to aggregated trauma and emergency surgical procedures that these patients underwent. Conclusions: Surgical fixation of rib fractures showed a significant benefit in the clinical outcome of patients presented.
||Thoracic trauma, rib fractures, flail chest, surgical fixation, chest wall reconstruction.
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>Year 2017, Issue 4