[Indications and methods for the surgical stabilization of an unstable thorax caused by multiple fractures of the ribs (author's transl)].

Every year 8,000 persons involved in road accidents die of irreversible respiratory insufficiency caused by chest injuries. Fractures of the ribs extendig over a number of ribs are present in 70% of the cases and in 15% of them they are accompanied by instability of the thorax and "paradoxical" respiration. Treatment of the instability by "internal pneumatic splinting" (Avery) and by surgical measures is reviewed. Indications for the latter are: (1) open fractures of the chest wall; (2) instability of the thorax combined with intrathoracic injuries; (3) instability of the chest wall with severe therapy-resistant respiratory insufficiency. In a series of animal experiments unilateral instability of the chest wall was induced by multiple rib fractures. By measuring oscillatory resistance before and after stabilization of chest wall the effects of the latter on the impaired lung function could be demonstrated. The results of the experiments indicate that with this type of surgical treatment mortality from combined thoracic injuries with paradoxical breathing can be reduced.