• Peter L Althausen, Steven Shannon, Chad Watts, Kenneth Thomas, Martin A Bain, Daniel Coll, Timothy J O'mara, and Timothy J Bray.
• Reno Orthopaedic Clinic, Reno, NV, USA. palthausen@sbcglobal.net
• J Orthop Trauma. 2011 Nov 1;25(11):641-7.

ObjectivesTo compare the results of surgical stabilization with locked plating to nonoperative care of flail chest injuries.DesignRetrospective case-control study.SettingLevel II trauma center.Patients/ParticipantsFrom January 2005 to January 2010, 22 patients with flail chest treated with locked plate fixation were compared with a matched cohort of 28 nonoperatively managed patients at our institution.InterventionOpen reduction internal fixation of rib fractures with 2.7-mm locking reconstruction plates.Main Outcome MeasurementsDemographic data, such as age, sex, injury severity score, number of fractures, and lung contusion severity, were recorded. Intensive care unit data concerning length of stay (LOS), tracheostomy, and ventilator days were noted. Operative data, such as time to OR, operative time, and estimated blood loss, were recorded. Hospital data, including total hospital LOS, need for reintubation, and home oxygen requirements, were documented.ResultsAverage follow-up period of operatively managed patients was 17.84 ± 4.51 months, with a range of 13-22 months. No case of hardware failure, hardware prominence, wound infection, or nonunion was reported. Operatively treated patients had shorter intensive care unit stays (7.59 vs. 9.68 days, P = 0.018), decreased ventilator requirements (4.14 vs. 9.68 days, P = 0.007), shorter hospital LOS (11.9 vs. 19.0 days, P = 0.006), fewer tracheostomies (4.55% vs. 39.29%, P = 0.042), less pneumonia (4.55% vs. 25%, P = 0.047), less need for reintubation (4.55% vs. 17.86%, P = 0.34), and decreased home oxygen requirements (4.55% vs. 17.86%, P = 0.034).ConclusionsThis study demonstrates the potential benefits of surgical stabilization of flail chest with locked plate fixation. When compared with case-matched controls, operatively managed patients demonstrated improved clinical outcomes. Locked plate fixation seems to be safe as no complications associated with hardware failure, plate prominence, wound infection, or nonunion were noted.

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