Ahmed Z, Mohyuddin Z
A total of 427 patients with major chest trauma were treated in two
major hospitals in Abu Dhabi, United Arab
Emirates, during a 10-year period. In 64 of 426 patients, flail chest
injury was the dominant factor among other injuries
that were insignificant. Among 64 cases of flail chest injury, 25 were
managed by internal fixation of ribs, whereas the
remaining 38 were managed by endotracheal intubation and intermittent
positive-pressure ventilation alone. Of the
patients treated by internal fixation 80% (21/26) were weaned from
the ventilator within an average of 1.3 days,
whereas the remaining 20% (5/26) continued to need assisted ventilation
for a longer duration; the total average duration of assisted ventilation
for the whole group was 3.9 days. In comparison, among 38 patients with
flail chest injury treated by endotracheal intubation and ventilation alone,
the average duration of assisted ventilation was 15 days. In the group
treated by internal fixation 11% (3/26) of the patients ultimately required
a tracheotomy, whereas in the patients treated by intubation and
ventilation alone tracheostomy was required in 37% (14/38) of the cases.
In the group treated by internal fixation, chest infection was documented
in 15% (4/26), septicemia in 4% (1/26), and barotrauma in 0%; in the other
group these complications occurred in 50% (19/38), 24% (9/38), and 8% (3/38)
of the cases, respectively. The mortality rate was 8% (2/26) in the surgically
treated patients, whereas it was 29% (11/38) in the other group. All the
deaths in both groups were ascribed to adult respiratory distress syndrome.
Average stay in the intensive care unit was 9 days for the patients treated
by internal fixation, whereas it was 21 days in the group treated by intubation
and ventilation alone. The treatment of flail chest injury in our series
by internal fixation resulted in speedy recovery, decreased complications,
and better ultimate cosmetic and functional results and proved to be cost
effective.
PMID: 8523879, UI: 96101766
