Sat., 10/16/10 Polytrauma & Femur, Paper #67, 10:23 am OTA-2010
Surgical Stabilization of Flail Chest with Locked Plate Fixation
Peter L. Althausen, MD1; Daniel Coll, PAC2; Timothy O’Mara, MD1; Timothy J. Bray, MD1;
1Reno Orthopaedic Clinic, Reno, Nevada, USA;
2Renown Regional Medical Center, Reno, Nevada, USA
Purpose: Flail chest occurs in about 10% of patients with chest trauma, carrying an associated mortality rate of 10% to 15%. The standard of care has become selected ventilatory support and tracheostomy when indicated. This treatment algorithm has been complicated by multiple cases of prolonged ventilatory support, pneumonia, empyema, respiratory insufficiency, and chronic pain. Long-term disability has been reported in over one-third of these patients. Over the last few years, surgical stabilization has become increasingly popular but there are few reports of locked plate fixation. The primary objective of this study is to compare the results of surgical stabilization with locked plating to nonoperative care of flail chest injuries.
Methods: From January 2005 to January 2010, 21 patients with flail chest were treated with locked plate fixation. Flail chest was defined as fractures of 4 or more ribs fractured at more than 2 sites. Data with regard to age, sex, mechanism, injury severity score (ISS), number of rib fractures, and severity of lung contusion was collected. These patients were compared to an age, mechanism, and ISS-matched cohort of nonoperatively managed patients at our institution. ICU data were collected on length of stay (LOS), time on ventilator, complications, epidural, anesthesia, and antibiotic requirements. Operative data such as time to operating room, operative time, estimated blood loss (EBL), operative cost, and complications was collected. Total hospital LOS, need for reintubation, and home oxygen requirements were recorded. Patients were contacted to assess pain scores and return to full employment. Clinic charts were reviewed to identify any complications of care such as posttraumtic pneumonia, wound infection, plate failure, and nonunion. Cost data with regard to ICU LOS, hospital LOS, operative costs (rib fixation, tracheostomy, chest tube placement, bronchoscopy), pain medicine requirement (epidural, patient-controlled analgesia, narcotics), and antibiotic use were analyzed.
Results: Average follow-up of operatively managed patients was 26 months. No case of hardware failure, hardware prominence, wound infection, or nonunion was reported. Operatively treated patients had shorter ICU stays (2.1 vs 7.3 days), shorter hospital LOS (5.2 vs 13 days), fewer tracheostomies(0 vs 5), decreased home oxygen requirements(30% vs 100%), 70% less narcotic use, and less need for reintubation (0 vs 4). Overall cost of operative patients was significantly less than nonoperatively managed patients.
Conclusions: This study demonstrates the potential benefits of surgical stabilization of flail chest with locked plate fixation. When compared to case-matched controls, operatively managed patients demonstrated improved clinical outcomes and decreased hospital costs. Locked plate fixation is safe as no complications associated with hardware failure, plate prominence, wound infection, or nonunion were noted.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.