Functional results after chest wall stabilization with a new screwless fixation device

Area of Science:

• Thoracic surgery
• Trauma surgery
• Orthopedic surgery

Background:

• Rib fractures, particularly flail chest and multiple dislocated fractures, pose significant management challenges.
• Chest wall deformity and instability can lead to impaired respiratory function and chronic pain.

Purpose of the Study:

• To evaluate the experience with the Stratos screwless rib fixation system for managing flail chest and dislocated rib fractures.
• To assess the clinical and functional outcomes of chest wall stabilization using this device.

Main Methods:

• A consecutive series of 94 patients with flail chest (n=68) or dislocated rib fractures (n=26) were treated with the Stratos system.
• Open reduction internal fixation (ORIF) involved flexible titanium rib clamps and plates.
• Postoperative assessment included clinical evaluation, pulmonary function tests (functional vital capacity - FVC), and magnetic resonance imaging (MRI) for radiological vital capacity (rVC) in flail chest patients at 6 months.

Main Results:

• The Stratos system demonstrated low morbidity (6.4%) and 30-day mortality (1.1%).
• At 6 months, patients showed restored chest wall integrity, symmetrical shoulder mobility (88%), and minimal functional restriction (median FVC ratio 88%, mean rVC 92%).
• Stabilization of more than four ribs was associated with a lower median rVC.

Conclusions:

• The Stratos screwless rib fixation device enables safe and effective chest wall stabilization for flail chest and dislocated rib fractures.
• The technique leads to early restoration of chest wall integrity and respiratory function with minimal long-term functional limitation.
• The simplicity and safety of the fixation technique support expanding its indications to selected patients with painful, dislocated rib fractures.