[Severe injury to the chest wall--experience with surgical therapy].

INTRODUCTION

Chest wall instabilities after extensive injuries of its skeleton belong to the most serious chest trauma with a relatively high rate of complications and mortality, mainly due to its pathophysiological consequences for the respiratory system.

OBJECTIVE

Retrospective analysis of an almost ten year file of injured patients treated with surgical stabilisation using instrumentation from Medin a. s. Company, Nové Mesto na Morave.

PATIENTS AND METHODS

From the end of 1997 to the middle of 2006, 40 patients were treated with metallic fixation of the chest by the authors; including 35 men and 5 women with an average age of 50.4 years. Almost x of the cases represented block fractures of the ribs, flail chest type, separately or in combination with a fracture of the sternum. Traffic accidents predominated in the mechanisms of injury (75 %). More then three fourth of chest instabilities resulted from severe polytrauma.

RESULTS

On average 4 plates were used for metallic fixation, 26 patients were indicated for the procedure directly due to chest wall instability; thoracotomy preceded in 9 patients with treatment of intrathoracic injury. Surgical stabilisation was performed in the mean on the 3.7 (th) day after injury. The period of subsequent artificial pulmonary ventilation usually did not exceed a week. One patient in the file died on sepsis due to bilateral bronchopneumonia (2.5 %), postoperative complications occurred in one fifth of patients, re-operation was performed in 16 patients. After a period of 11 months on average the implants were so far removed in 12 patients (30 %).

CONCLUSION

Our experience with metallic fixation of the unstable chest wall is mainly positive. Decisive for the success of this procedure is the correct indication respectively selection of patients that will have a benefit from the surgical stabilisation.