Flail chest, often defined as the fracture of three or more ribs in two or more places,
represents the most severe form of rib fractures. Conservative treatment, consisting of
respiratory assistance with endotracheal intubation and mechanical ventilation (internal
pneumatic stabilization) and pain control, are the current treatments of choice in the
majority of patients with multiple rib fractures. However, the use of mechanical ventilation
may create complications. In selected patients, operative fixation of fractured ribs within
72 h post injury may lead to better outcomes. We conducted a retrospective analysis
of a series of nine cases of patients who developed flail chest after blunt trauma, and
were treated with surgical osteofixation of the chest wall and postoperative epidural
analgesia at the University Clinical Center of the Republic of Srpska during the period
from January 2015. to December 2016. Two patients had trauma to the chest only, and
the other patients had associated injuries to the head, abdomen, spine, and fractures
of the pelvis and long bones. In the majority of patients (77.7%), surgical stabilization of
the chest was performed on the second day following the injury, (mean, 2.33 days) and
no later than 5 days after the injury. All patients received epidural analgesia with 0, 25%
bupivacaine and 0, 01% morphine and intravenous multimodal analgesia, beginning 6 h
after thoracotomy. The average length of ICU stay was 14.7 days (range 2–36), while
the average number of days of mechanical ventilation was 8.1. The average duration of
hospitalization was 25.4 days. Tracheotomy was performed in 33.3% of study patients.
Mortality in the observed group was 44.4%. This study shows that surgical stabilization
and epidural analgesia reduced ventilator support, shortened trauma intensive care unit
stay, and reduced medical costs vs internal pneumatic stabilization.
