[Biomechanics of thoracic wall instability]

Area of Science:

• Biomechanics
• Thoracic Surgery
• Trauma Research

Context:

• Traumatic thoracic injuries can cause flail chest, impacting thoracic shape and respiratory function.
• Current understanding of the biomechanics of unstable thoracic walls and optimal surgical fixation is limited.
• Existing experimental models for simulating physiological forces are often unvalidated and restricted.

Purpose:

• To review current research on experimental models and findings related to thoracic wall instability.
• To highlight the biomechanical necessity of osteosynthesis for restoring thoracic function.
• To compare the efficacy of different osteosynthesis methods.

Summary:

• Osteosynthesis is biomechanically crucial for unstable thoracic walls to restore native respiratory mechanics, thoracic shape, and spinal stability.
• In vitro studies indicate plate osteosynthesis provides better stabilization than intramedullary splints, wires, or screws.
• The optimal number and selection of ribs for fixation in various thoracic wall instability types remain biomechanically undetermined.

Impact:

• Findings underscore the importance of biomechanical considerations in surgical fixation of flail chest.
• Highlights the superiority of plate osteosynthesis for thoracic wall stabilization.
• Identifies critical knowledge gaps and directs future biomechanical research towards validated models simulating respiratory and spinal movements.