J Thorac Cardiovasc Surg 2009;138:1239-1240
© 2009 The American Association for Thoracic Surgery
The novel use of Nuss bars for reconstruction of a massive flail chest
Paul E. Pacheco, MDa,*,
Alex R. Orem, BAa,
Ravindra K. Vegunta, MD, FACSa,b,
Richard C. Anderson, MD, FACSa,b,
Richard H. Pearl, MD, FACSa,b
a Department of Surgery, University of Illinois College of Medicine at Peoria, Peoria, Ill
b Children's Hospital of Illinois at OSF St. Francis Medical Center, Peoria, Ill
Received for publication March 23, 2008; revisions received June 14, 2008; accepted for publication July 6, 2008.
* Address for reprints: Paul E. Pacheco, MD, Children's Hospital of Illinois at OSF St Francis Medical Center, 420 NE Glen Oak Dr, Suite 201, Peoria, IL 61603. (Email: pacheco7@gmail.com).
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Introduction
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We present the case of a patient who sustained a massive flail chest from a snowmobile accident. All ribs of the right side of the chest were fractured. Nonoperative management was unsuccessful. Previously reported methods of rib stabilization were precluded given the lack of stable chest wall elements to fixate or anchor the flail segments. We present a novel surgical treatment in which Nuss bars can be used for stabilization of the most severe flail chest injuries, when reconstruction of the chest is necessary and fixation of fractured segments is infeasible owing to adjacent chest wall instability.
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Clinical Summary
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The patient was a 40-year-old male snowmobile driver who was hit by a train. Evaluation revealed severe multiple right-sided rib fractures, right scapular and clavicular fractures, and a left femur fracture. A thoracostomy tube was placed and intubation with mechanical ventilation instituted. With stability, he was taken for intramedullary nailing of the femur. Despite conventional efforts, he was unable to be . . . [Full Text of this Article]
Copyright © 2009 by The American Association for Thoracic Surgery.
