The strategy for treatment of flail chest remains controversial. Debate between MV and surgical fixation persisted for years.
Objectives: To compare the effectiveness and early outcome between two methods for management of flail chest patients; one of them is MV and the other is surgical fixation.
Patients and methods: The study included forty patients. They were grouped into two groups. In group I: twenty patients were managed by MV using IMV mode with PEEP and in group II: twenty patients were treated by surgical internal fixation either by plates and screws, plates and stainless steel wires or by stainless steel wires alone. In group II; patients were managed under general anesthesia.
Results: In group I, age ranged from 18-67 with mean 36.7 ± 14.5 and 18 males and 2 females were included. Also stability of chest wall occurred in 5 (25%) patients in this group. While in group II age ranged from 18-69 with mean 39.05 ± 17.8 and 19 males and 1 female were included. Also stability of chest wall occurred in 18 (90%) patients in this group. We used plates for fixation together with screws and stainless steel wires with which we observed more stability than the mere use of wires or absorbable sutures alone. There was significant difference regarding the mean duration of mechanical ventilation, ICU stay, stability of chest wall and incidence of chest infection between both groups. There was no statistical significant difference between both groups regarding hospital stay, morbidity and mortality although it is lower in the surgical group.
Conclusion: Surgical fixation is a successful treatment modality in patients with traumatic flail chest as it avoids long term mechanical ventilation, resulting chest infection and allows early discharge from ICU with less mortality, but at certain situations.
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