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J Thorac Cardiovasc Surg 1996;112:850
© 1996 Mosby, Inc.

LETTERS TO THE EDITOR

On internal fixation for flail chest

PO Box 28233
Abu-Dhabi, United Arab Emirates

Reply to the Editor:

The reasons for respiratory embarrassment in flail chest injury are multiple, but the pain arising from movement of the spiky fractured ribs during the respiratory cycle plays a crucial role. Abolition of movement at the fracture sites is a key factor in minimizing the pain and improving pulmonary function. Different techniques including the use of various suture materials have been proposed to achieve internal fixation of the fractured ribs in flail chest injury. The aim of internal fixation is not just to achieve mere proximity of the two ends of a fractured rib. It is rather stabilization which is sought, and no amount of suturing with Vicryl sutures (Ethicon, Inc., Somerville, N.J.) can help to accomplish this objective. Bringing the two ends of a fractured rib together with Vicryl sutures would continue to allow movement at the fracture site during respiration, and this would negate the very purpose of internal fixation. The major reason for the pain would continue to be present, and the paradoxic movements of the flail segment would not be effectively curtailed because of the lack of provision of rigid support to the fractured ribs. Lack of stability would also ultimately hamper the effective clearance of bronchial secretions, by coughing, and lung expansion.

Another important point raised concerns the difficulty encountered in pinning the fracture sites in awkward locations. We do not advocate fixation of every single fractured rib. Pinning of even a few easily accessible sites is sufficient to allow normal respiratory physiology and can easily be accomplished through standard thoracotomy incisions.

Finally, regarding the question of splitting of ribs as a result of the use of the technique in question, it is understandable that use of any disproportionate force could make the matter worse. On the contrary, however, gentle and careful handling can obviate such mishaps. We have never encountered insurmountable difficulty with this technique. Once the entry of the Kirschner wire into the medullary cavity of a rib has been ensured, its further negotiation across the fracture site is fairly smooth and easy.

12/8/74180

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ahmed, Z. Search for Related Content PubMed PubMed Citation Articles by Ahmed, Z.