Citation

Dehghan N, Mah JM, Schemitsch EH, Nauth A, Vicente M, McKee MD. J. Orthop. Trauma 2018; 32(1): 15-21.

Affiliation

1 Orthopaedic Surgeon - The CORE Institute and Banner University Medical Center, Phoenix, Arizona, USA; Affiliate Scientist, Li Ka Shing Institute, St. Michael's Hospital and the University of Toronto, Toronto, Canada. 2 Research student - St. Michael's Hospital and the University of Toronto, Toronto, Canada. Student, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Canada. 3 Chair/Chief of Surgery, Professor, Division of Orthopaedics, Department of Surgery, Western University, London, Canada 4 Assistant Professor, Division of Orthopaedics, Department of Surgery, St. Michael's Hospital and the University of Toronto, Toronto, Canada 5 Research coordinator, St. Michael's Hospital and the University of Toronto, Toronto, Canada 6 Professor, Division of Orthopaedics, Department of Surgery, St. Michael's Hospital and the University of Toronto, Toronto, Canada.

Copyright

(Copyright © 2018, Lippincott Williams and Wilkins)

DOI

10.1097/BOT.0000000000000992

PMID

28902086

Abstract

OBJECTIVE: To determine the prevalence, management and outcomes of patients with flail chest injuries, compared to patients without flail chest injuries (single rib fractures and multiple rib fractures without a flail segment).

DESIGN: Retrospective cohort study SETTING:: Ontario, Canada PARTICIPANTS:: Ontario residents over the age of 16 who had been admitted to hospital with a chest wall injury from 2004 to 2015 were identified using administrative health care databases. MAIN OUTCOME MEASUREMENTS: Outcomes included treatment modalities such as rate of surgical repair, days on mechanical ventilation, days in the intensive care unit (ICU), days in hospital, rate of chest tube placement; and rates of complication, including pneumonia, tracheostomy, readmission, and death.

RESULTS: In total 117,204 patients with fractures of the chest wall were identified. Of the entire cohort, 1.5% of had a flail chest injury, 41% had multiple rib fractures and 58% had single rib fractures. Flail chest patients had significantly worst outcomes compared to multiple rib fracture patients in all categories (p<0.0001). Similarly, multiple rib fracture patients had significantly worst outcomes compared to single rib fracture patients (p<0.0001). Only 4.5% of flail chest patients were treated surgically, however the number increased from 1% prior to 2010 to 10% after 2010 (p<0.0001). After adjustment for potential confounders, patients with flail chest injuries treated surgically had a reduced risk of early mortality compared to those treated non-operatively (OR 0.16, p=0.019).

CONCLUSIONS: Surgical stabilization of flail chest has increased significantly in recent years. The results of this study provide preliminary evidence that the increasing rate of surgical intervention may be warranted by reducing mortality. LEVEL OF EVIDENCE: Level III.

Language: en