Video-assisted thoracoscopic surgery surgical stabilization of rib fractures: surgical technique and case report

Rib fractures are a common consequence of chest trauma. In some instances, the presence of rib fractures may cause chest instability, leading to respiratory failure, dependance from ventilatory support and increased risk of pulmonary infections. Surgical stabilization of rib fractures (SSRF) is a well-established treatment to restore the stability of the rib cage and prevent respiratory complications. While this procedure is commonly performed through an open approach that allows a wide exposure of the ribs surface, in recent years a minimally invasive procedure consisting in thoracoscopic-assisted rib plating has been introduced. The lower invasiveness of this technique is associated with excellent post-operative outcomes. We present the case of a patient with post-traumatic flail chest treated with thoracoscopic rib stabilization, with a video describing the surgical procedure step-by-step. The sixth and the seventh left rib were stabilized with dedicated intrathoracic bridges. Surgery time was 120 minutes. The patient was extubated 8 hours after surgery. Pain score decreased from 6/10 to 2/10 according to the Numeric Rating Scale and respiratory parameters improved, with partial pressure of arterial oxygen (PaO₂)/inspiratory fraction of oxygen (FiO₂) increasing from 250 to 420. Discharge occurred on post-operative day 8. Thoracoscopic rib plating demonstrated to be a viable, seemingly less invasive treatment option for rib fractures with chest instability. The lower invasiveness of a minimally invasive approach and the anatomical basis to favor an intrathoracic deployment of the costal implants makes the procedure particularly suitable for this indication. Comparative prospective trials are required to confirm our findings.