Operative management of the flail chest

The management of flail chest (FC) has been the subject of controversy for many years. The aim of our study was to compare results of the management of patients with FC after operative stabilization (OS) vs. nonoperative treatment (NT). One hundred and thirty-three consecutive patients with FC were assigned to treatment with OS (40 patients) and NT (93 patients). Different kinds of external extramedullar osteosynthesis were performed within 24 hour period after admission. NT includes endotracheal lung ventilation, epidural and regional anaesthesia. No difference in age, sex, shock ISS, severity pulmonary and heart contusion, extensive FC were found between both groups. Results of treatment are the following (for OS and NT respectively, p < 0.05): pneumonia 15% (6) vs. 34.4% (32); PaO2/FiO2 - 333.4 +/- 12.3 vs. 286.5 +/- 14.7; duration of lung ventilation (days) - 2.3 +/- 0.6 vs. 6.3 +/- 1.2; mortality rate - 22.5% (9) vs. 46.2% (43). Operative stabilization of chest wall should be considered when extensive FC occurs, particularly for patients with severe pulmonary and heart contusion.