[Osteosynthesis of the unstable thoracic wall]

Area of Science:

• Trauma Surgery
• Thoracic Surgery
• Surgical Critical Care

Background:

• Severe thoracic trauma, including flail chest and sternal fractures, presents significant biomechanical instability.
• Complications include prolonged ventilator dependency, pneumonia, and increased mortality.
• Non-surgical management often fails to adequately address these complex injuries.

Purpose of the Study:

• To evaluate the efficacy of early surgical stabilization for severe thoracic trauma.
• To assess the impact of surgical intervention on ventilator dependency and associated complications.
• To determine optimal timing and strategy for surgical intervention in polytraumatized patients.

Main Methods:

• Retrospective study of 15 polytraumatized patients.
• Early interdisciplinary surgical treatment strategy within 24-48 hours.
• Open or minimally invasive reduction and osteosynthesis using locking plates and/or intramedullary splints.
• Clinical and radiological parameter assessment.

Main Results:

• Early osteosynthesis significantly reduced ventilator dependency and pneumonia risk compared to delayed surgery.
• Patients with severe thoracic trauma (Abbreviated Injury Score ≥ 3) experienced longer intensive care unit stays and hospital admissions.
• Successful weaning from respirator was facilitated by early stabilization.

Conclusions:

• Early surgical stabilization is a beneficial strategy for patients with severe thoracic trauma and flail chest.
• A thoroughly planned, interdisciplinary approach is essential for optimal patient outcomes.
• Timely intervention can mitigate complications associated with prolonged mechanical ventilation.