Flail Chest with pulmonary contusion and multiple rib fractures

Rib Fractures

Most rib fractures, although painful and troublesome,  heal uneventfully without the need for surgical intervention.  A small subset of patients with rib injuries have segmental involvement of several consecutive ribs leading to a condition known as "flail chest".  Most of these are high energy injuries that cause profound pulmonary problems and require a mechanical ventilation. These injuries are caused by high energy trauma such as car accidents or crush injuries.   Patients with this condition can be treated by repairing the rib fractures with small plates which stabilizes the bony cage of the chest wall.  Repair of the rib fractures is very beneficial to lung function and often allows patients to be taken off the respirator much earlier than those who do not undergo repair. I perform this type of surgery in conjunction with a thoracic surgeon so that any injury to the lung itself can be repaired concomitantly.  The surgery takes 2-3 hours and recovery is dependent on the extent of the damage to the lung and other injuries.  The primary benefit of rib repair is improvement of long term lung function, reduction in chronic pain associated with deformities of the thoracic cage and prevention of rib malunions/ non unions.  

Patients who have these types of injuries and do not undergo surgical repair often  painful rib "malunions". This is  a condition in which the ribs heal in a deformed position. Many of these patients have  chronic pain and lung dysfunction but the mechanism by which this happens is not well understood. Each rib has an paired nerve and artery that run on the undersurface of the rib.  In patients with large residual fracture deformity, the nerve is often damaged leading to chronic pain.  Patients that have this condition can be helped by repairing the malunion and correcting the deformity of the chest wall.  This restores the thoracic cage to its original shape and improves both lung function and reduces the chronic pain that often accompanies these injuries.

I have published peer reviewed manuscripts on the repair of rib fractures using a tissue sparing technique that avoids the use of a thoracotomy (opening the chest cavity), which has been associated with long term shoulder dysfunction.  This technique allows me to access and repair the ribs without an extensive surgical dissection.  Patients recover more quickly and shoulder function improves faster than standard surgical approaches.  I treat about 6-8 patients per year for flail chest and malunion and currently have a clinical trial in progress to prospectively evaluate the outcomes of this procedure.

Flail Chest repair without Thoracotomy

Reference for rib plating via a minimally invasive surgical approach:

Solberg BD, Moon CN, Franco DP, Margulies DP. Treatment of Implosion flail chest without thoracotomy: Technique and clinical outcomes. Journal of Trauma  67(1):8-13, July 2009.