[Surgical stabilization of post-traumatic flail chest. Our experience with 116 cases treated]

The therapeutic approach in a patient with traumatic flail chest is varied and controversial, both as regards the type of treatment and as regards the surgical techniques to be employed. The authors have examined 116 cases of flail chest treated surgically; these represented 17.7% of the 655 chest traumas operated in the period from July 1975 to March 1993. Increasing experience has reduced indications for surgery: at present it is not performed in cases of serious craniocerebral lesions, of severe pulmonary contusions, or, however, when mechanical ventilation is required. As for surgical techniques, external traction was applied in the first 15 cases treated but then discontinued because of the poor outcome. Osteosynthesis (77 cases), associated with thoracotomy, was carried out with Kirschner wires, Vecsei metal plates, Judet agraffe, alone or variously combined. Recently, a less aggressive personal technique has been employed prevalently: Kirschner wires placed vertically within the chest, bridging between one rib (generally the V or VI, well fixed with metal plates), and the clavicle and/or sternum. The overall mortality rate, prevalently due to associated lesions, was 20.6%. Excluding emergencies, these patients should be operated in deferred emergency within 24-48 hours of trauma. Osteosynthesis, when indicated is the procedure offering the greatest assurance of success. The authors believe that, in selected cases, surgical stabilization is necessary.