Objective

Flail chest occurs in 5-13% of patients with chest wall trauma; mortality with conservative treatment is 10-20%. Other indications for surgical fixation which have received NICE approval include deformity and severe symptoms. This study describes the initial outcomes of a rib fixation program in the context of the best evidence that supports rib fixation.

Methods

Data was prospectively collected on all patients that underwent rib fixation between 2013-2015. We analysed the mechanism of trauma, co-morbidities, indications for surgery, operative outcomes and complications. We exclusively used matrixRIB™ fixation system composed of interlocking pre-contoured plates and locking screws.

Results

16 patients underwent unliateral chest fixation. 13/15 (87%) were polytrauma patients sustaining at least one other injury in two or more organ systems. Mean age was 57 (31-72). Mean duration from admission to fixation was 11 days, with most patients being referred median of 6 days post initial trauma. Post-operatively median time on invasive ventilation was significantly less post fixation 10±4 vs. 3±2days (P<0.05). There were no deaths and all patients remain well at median 15-month follow-up.

Conclusion

We discuss the indications for rib fixation in acute chest trauma and our experience of setting up a program as part of a dedicated cardiothoracic trauma service. We compare our results to the published data and review the best evidence on the topic. Data supports that surgical fixation decreases the length of mechanical ventilation, ICU stay, and mortality.