Flail Chest with pulmonary contusion and multiple rib fractures

Rib Fractures

Most rib fractures heal uneventfully without the need for surgical intervention.  A small subset of patients have segmental involvement of several consecutive ribs leading to a condition known as "flail chest".  Most of these are high energy injuries that cause profound pulmonary problems and require a mechanical ventilation.  Many patients with this condition can be treated by repairing the rib fractures which imparts stability to the bony cage of the chest wall.  Repair of the rib fractures is very beneficial to lung function in some cases and often allow patients to go without a respirator much earlier than those who do not undergo repair. 

A small subset of patients have painful rib "malunions" a condition in which the ribs heal in a deformed position. This can lead to chronic pain and lung dysfunction but the mechanism by which this happens is not well understood.  Some patients do benefit from surgical correction of the chest wall deformity and rib plating.

I have published on the repair of rib fractures using a tissue sparing technique that avoids the use of a thoracotomy, which has been associated with long term shoulder dysfunction.  This technique allows me to access and repair the ribs without an extensive surgical dissection.  Patients recover more quickly and shoulder function improves faster than standard surgical approaches

Flail Chest repair without Thoracotomy

Reference for rib plating via a minimally invasive surgical approach:

Solberg BD, Moon CN, Franco DP, Margulies DP. Treatment of Implosion flail chest without thoracotomy: Technique and clinical outcomes. Journal of Trauma  67(1):8-13, July 2009.