[Therapy of the unstable thorax in serial fractures of the ribs].

The histories of patients with flail chest and respiratory insufficiency caused by blunt chest injury have been analyzed. The first group represented patients with surgical stabilization of 3-4 ribs by introduction of "Rehbein plates" into the medullary cavity (10 patients 1972-1975). The patients of the second group have been supported by controlled mechanical respiration (11 patients 1972-1975). Patients with chest and further injuries (polyblessés) of comparable degree have been selected for both groups. The two groups were compared with regard to duration of intubation and artificial ventilation (average of 8.8 days for the operated and 21.4 days for the mechanically ventilated patients), stay in the intensive care unit (15.2 days after operation and 28.3 days for treatment by respirator) and average total hospitalization time (33.5 days after surgical management and 54.2 days after nonsurgical treatment). Severe bronchial infections caused by hospital germs have occurred more frequently in patients on long-term intubation and mechanical respiration. The average age of patients was almost the same in both groups. The technique of surgical stabilization of the ribs is described, and the advantages and limits of surgical and conservative management of respiratory insufficiency caused by flail chest are discussed.