Indication and Timing of Surgery Are Essential in Stabilization of the Chest Wall in Flail Chest Trauma Patients

Flail chest occur after blunt trauma to the thorax. Most often treatment of flail chest is conservative with analgesia and respiratory support, if needed. New plate systems and surgical approaches have improved outcomes after surgery. Surgical treatment of flail chest is associated with a reduced risk of severe pneumonia, shorter time with mechanical ventilation and a reduced length of stay in the Intensive Care Unit (ICU) compared to conservative treatment. However, currently approximately 1% of patients with flail chest undergo surgery. We are presenting two cases of flail chest treated surgically by fixating the most dislocated posterior fractures. One patient avoided mechanical ventilation, and the other patient was quickly weaned from respirator after surgery. We found that surgical stabilization of posterior fractures in patients with flail chest is a safe method with a high possibility of positive outcomes for the patients. Surgical stabilization of flail chest is indicated in patients with consistent pain (case 1) and increased risk of pneumonia, respiratory failure or prolonged mechanical ventilation (case 2). Furthermore, it was possible to achieve stable thorax wall by only fixating the most dislocated posterior fractures in the flail segment.