Treatment of flail chest using a simple and inexpensive costal osteosynthesis technique

Abstract

Flail chest, one of the most severe wall injuries in thoracic trauma, can be the cause of high mortality. Several techniques of osteosynthesis have been described depending on the material used. We present here a simple and inexpensive technique. <bold>Methods:</bold> We retrospectively collected patients who had post-traumatic costal flap and underwent osteosynthesis over a period going from March 2022 to January 2024. The surgical technique was based on the use of pins with passage into the medulla of the costal bone on one side of the fracture and through the cortex on the other side. <bold>Results:</bold> We collected 11 cases (9 men/2 women). The mean age was 53 years. Eight cases were victims of road accident and three had a household accident. All patients had a flail chest associated with a pulmonary contusions and pleural effusion. Four patients had bilateral rib fractures. Eight patients had additional extra thoracic injuries. Three patients required mechanical ventilation before surgery. The surgical approach was a posterolateral thoracotomy (n=4), anterior thoracotomy (n=4), axillary thoracotomy (n=1) or median anterior incision (n=2). Osteosynthesis was performed on 6 ribs (n=2), 3 ribs (n=3) and 2 ribs (n=6). For 2 cases, rib clips were associated to pins. The postoperative course was uneventful in 7 cases. Two patients were treated for a postoperative infectious complication. Two patients died within 30 postoperative days: one from septic shock and the other from intestinal bleeding. <bold>conclusion:</bold> Osteosynthesis of post-traumatic flail chest can radically change the prognosis of severe thorax trauma patients. The use of simple, inexpensive pins has shown its effectiveness but requires mastery of the technique.