@article{ref1,
title="Operative stabilization of flail chest injuries reduces mortality to that of stable chest wall injuries",
journal="Journal of Orthopaedic Trauma",
year="2018",
author="Dehghan, Niloofar and Mah, Jeffrey M. and Schemitsch, Emil H. and Nauth, Aaron and Vicente, Milena and McKee, Michael D.",
volume="32",
number="1",
pages="15-21",
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). <br><br>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. <br><br>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). <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="0890-5339",
doi="10.1097/BOT.0000000000000992",
url="http://dx.doi.org/10.1097/BOT.0000000000000992"
}