Surgical management of flail chest with titanium plates: a French cohort series from a thoracic referral center

Abstract Background The development of titanium claw plates has made rib osteosynthesis easy to achieve and led to a renewed interest for this surgery. We report the management of patients referred to the intensive care unit (ICU) of a referral center for rib fracture fixation after chest trauma.MethodsA retrospective observational cohort study describing the patients’ characteristics and analyzing the determinants of postoperative complications. Results From November 2013 to December 2016, 42 patients were referred to our center: 12 patients (29%) suffered acute respiratory failure, 6 of whom were mechanically ventilated. The Thoracic Trauma Severity Score (TTSS) was 11.0 [9-12], with 7 [5-9] broken ribs and a flail chest in 92% of cases. A postoperative complication occurred in 18 patients (43%). Five patients developed ARDS (12%). Postoperative pneumonia occurred in 11 patients (26%). Two patients died in the ICU. In multivariable analysis, the TTSS (OR=1.89; CI95% 1.12-3.17; p=0.016) and the Simplified Acute Physiology Score II without age (OR=1.17; CI95% 1.02-1.34; p=0.024) were independently associated with the occurrence of a postoperative complication.ConclusionThe TTSS score appears more accurate than the Injury Severity Score for determining thoracic trauma severity. Rib fixation may be harmful, and short and long-term benefit should be assessed, particularly in non-mechanically ventilated patients.