Management of rib fractures in traumatic flail chest

Bone and Joint Journal - Tập 98-B Số 8 - Trang 1119-1125 - 2016
Tim Coughlin1,2,3, J. Ng1,2, Katie E. Rollins4,2, Daren P. Forward5,2, B. Ollivere6,7
1Orthopaedic Registrar.
2Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
3e-mail:
4General Surgical Registrar
5Consultant Orthopaedic Trauma Surgeon
6Associate Clinical Professor
7University of Nottingham, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.

Tóm tắt

Aims Flail chest from a blunt injury to the thorax is associated with significant morbidity and mortality. Its management globally is predominantly non-operative; however, there are an increasing number of centres which undertake surgical stabilisation. The aim of this meta-analysis was to compare the efficacy of this approach with that of non-operative management. A systematic search of the literature was carried out to identify randomised controlled trials (RCTs) which compared the clinical outcome of patients with a traumatic flail chest treated by surgical stabilisation of any kind with that of non-operative management. Results Of 1273 papers identified, three RCTs reported the results of 123 patients with a flail chest. Surgical stabilisation was associated with a two thirds reduction in the incidence of pneumonia when compared with non-operative management (risk ratio 0.36, 95% confidence interval (CI) 0.15 to 0.85, p = 0.02). The duration of mechanical ventilation (mean difference -6.30 days, 95% CI -12.16 to -0.43, p = 0.04) and length of stay in an intensive care unit (mean difference -6.46 days, 95% CI 9.73 to -3.19, p = 0.0001) were significantly shorter in the operative group, as was the overall length of stay in hospital (mean difference -11.39, 95% CI -12.39 to -10.38, p < 0.0001). Surgical stabilisation for a traumatic flail chest is associated with significant clinical benefits in this meta-analysis of three relatively small RCTs. Cite this article: Bone Joint J 2016;98-B:1119–25.

Từ khóa


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Thông tin
Thông tin xuất bản

Bone and Joint Journal

Tập 98-B Số 8

1119-1125

Thông tin tác giả