Title : Flail chest external fixation
Abstract:
Introduction: Rib fractures are a frequently identified injury in the trauma population. Nonoperative treatment is based on pain control and aggressive supportive pulmonary care primarily aimed at avoiding the need for intubation, which is associated with increased rates of pneumonia and death. For patients who continue to have acute pain or inherent chest wall instability (eg, flail chest), either of which hinders pulmonary function, in spite of maximal medical therapy, or those with rib fractures that do not heal and are causing persistent pain and functional impairment, surgical rib stabilization may be needed.
Methods and Objectives: Male patient, 32 years old, exposed to road traffic accident.
Trauma assessment : At time of ER. presentation patient was conscious, pain score 10, pain control had addressed by trauma team, patient exposure, wide caliber peripheral lines introduced, splinting for apparent limb disabilities (Rt. Forearm, Rt. Leg open fracture care and splinting and Lt. leg). As patient develop chest tightness with visible paradoxic chest segment at upper Lt. side of chest wall, Lt. side chest tube had introduced by cardiothoracic surgeon and intubation had done, mechanical ventilation on full respiratory support parameters, patient transferred to ICU. And radiological assessment had done which revealed that:
- Bilateral both bone leg fractures Rt. Side was open fracture grade IIIa,
- Multiple ribs fracture and heamopnumothorax Rt. Side.
- Multiple ribs fractures and heamopnumothorax Lt. side.
- Facture both bones Rt. Forearm.
- Non surgical abdomen.
Rt. Side chest tube had introduced by cardiothoracic surgeon which sealed about 1500cc blood, hemoglobin concentration 7 g/dl at time of presentation which lowing down on sequential laboratory assessment and had replaced. Paradoxical segment located at upper Lt. side opposing 2nd, 3rd and 4th ribs had revealed on examination and documented by paradoxic wave on respiratory curve at the monitor. Patient get desaturated as Rt. Lung had severely contused and Lt. lung had paradoxic respiration and patient was not fit for ribs internal fixation so we had proceeded to do ribs external fixation and closed stabilization of paradoxic segment utilizing ilizarov accessories under complete sterile condition as a bedside procedure.
Results:
Paradoxic wave dramatically disappeared on respiratory curve at the monitor which can be used as a guidance sign for accurate fixation, pulmonary support parameters got decreased by 30% on ventilator instead of 100% , Lt lung start to be re-inflated at the beginning of the 2nd week
Conclusion :
Ribs external fixation in polytraumatized patients is life saving minimal invasive procedure and has to be validated .
