Pulmonary function testing after operative stabilisation of the chest wallfor flail chest

Objective: This is a prospective evaluation of chest wall integrity and pul monary function in patients with operative stabilisation for flail chest in juries. Methods: prom 1990 to 1999, 66 patients (56 men, 10 women; mean age 52.6 years) with antero-lateral flail chest (greater than or equal to4 rib s fractured at greater than or equal to2 sites) underwent surgical stabilis ation using reconstruction plates. Clinical assessment and pulmonary functi on testing were performed at 6 months following surgery. Results: Fifty-fiv e (83%) patients had various combinations of injuries of the thorax, head, abdomen and extremities. Sixty-three (95.5%) patients underwent unilateral and 3 (4.5%) patients bilateral stabilisation with a median delay of 2.8 da ys (range 0-21 days) from admission. The 30-day mortality was 11% (seven of 66 patients). Immediate postoperative extubation was feasible in 31 of 66 patients (47%) and extubation within 7 days following stabilisation in 56 o f 66 patients (85%). No plate dislocation was observed during the follow-up . The shoulder girdle function was intact in 51 of 57 patients (90%). Chest wall complaints were noted in 6 of 57 (11%) patients, requiring removal of implants in three cases. All patients returned to work within a mean perio d of 8 (range 3-16) weeks following discharge. Pulmonary function testing ( n=50) at 6 months after the operation revealed a significant difference of predicted vs. recorded vital capacity (VC) and forced expiratory volume in 1 s (FEV1) (P=0.04 and P=0.0001, respectively; WiIcoxon signed-rank test). The median ratio of the recorded and predicted total lung capacity (TLC) wa s shown to be significantly higher than 0.85 (P=0.0002; Wilcoxon signed-ran k test), indicating prevention of pulmonary restriction. Conclusion: Antero -lateral flail chest injuries accompanied by respiratory insufficiency can be effectively stabilised using reconstruction plates. Early restoration of the chest wall integrity and respiratory pump function may be cost effecti ve through the prevention of prolonged mechanical ventilation and restricti on-related working incapacity. (C) 2001 Elsevier Science B.V. All rights re served.