Prospective randomized controlled trial of operative rib fixation in traumatic flail chest

J Am Coll Surg. 2013 May;216(5):924-32. doi: 10.1016/j.jamcollsurg.2012.12.024. Epub 2013 Feb 13.


Background: Traumatic flail chest injury is a potentially life threatening condition traditionally treated with invasive mechanical ventilation to splint the chest wall. Longer-term sequelae of pain, deformity, and physical restriction are well described. This study investigated the impact of operative fixation in these patients.

Study design: A prospective randomized study compared operative fixation of fractured ribs in the flail segment with current best practice mechanical ventilator management. In-hospital data, 3-month follow-up review, spirometry and CT, and 6-month quality of life (Short Form-36) questionnaire were collected.

Results: Patients in the operative fixation group had significantly shorter ICU stay (hours) postrandomization (285 hours [range 191 to 319 hours] for the surgical group vs 359 hours [range 270 to 581 hours] for the conservative group; p = 0.03) and lesser requirement for noninvasive ventilation after extubation (3 hours [range 0 to 25 hours] in the surgical group vs 50 hours [range 17 to 102 hours] in the conservative group; p = 0.01). No differences in spirometry at 3 months or quality of life at 6 months were noted.

Conclusions: Operative fixation of fractured ribs reduces ventilation requirement and intensive care stay in a cohort of multitrauma patients with severe flail chest injury.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Female
  • Flail Chest / diagnostic imaging
  • Flail Chest / etiology*
  • Flail Chest / surgery*
  • Flail Chest / therapy
  • Follow-Up Studies
  • Fracture Fixation, Internal* / methods
  • Humans
  • Imaging, Three-Dimensional
  • Intensive Care Units
  • Length of Stay
  • Male
  • Middle Aged
  • Noninvasive Ventilation
  • Odds Ratio
  • Prospective Studies
  • Quality of Life
  • Rib Fractures / diagnostic imaging
  • Rib Fractures / etiology*
  • Rib Fractures / surgery*
  • Rib Fractures / therapy
  • Spirometry
  • Surveys and Questionnaires
  • Thoracic Injuries / complications*
  • Thoracic Injuries / therapy
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome