Pulmonary function testing after operative stabilisation of the chest wall for ¯ail chestq

Objective: This is a prospective evaluation of chest wall integrity and pulmonary function in patients with operative stabilisation for ¯ail chest injuries. Methods: From 1990 to 1999, 66 patients (56 men, 10 women; mean age 52.6 years) with antero-lateral ¯ail chest ($4 ribs fractured at $2 sites) underwent surgical stabilisation using reconstruction plates. Clinical assessment and pulmonary function testing were performed at 6 months following surgery. Results: Fifty-®ve (83%) patients had various combinations of injuries of the thorax, head, abdomen and extremities. Sixty-three (95.5%) patients underwent unilateral and 3 (4.5%) patients bilateral stabilisation with a median delay of 2.8 days (range 0±21 days) from admission. The 30-day mortality was 11 % (seven of 66 patients). Immediate postoperative extubation was feasible in 31 of 66 patients (47%) and extubation within 7 days following stabilisation in 56 of 66 patients (85%). No plate dislocation was observed during the follow-up. The shoulder girdle function was intact in 51 of 57 patients (90%). Chest wall complaints were noted in 6 of 57 (11%) patients, requiring removal of implants in three cases. All patients returned to work within a mean period of 8 (range 3±16) weeks following discharge. Pulmonary function testing \u85n 50 at 6 months after the operation revealed a signi®cant difference of predicted vs. recorded vital capacity (VC) and forced expiratory volume in 1 s (FEV1) (P 0:04 and P 0:0001, respectively; Wilcoxon signed-rank test). The median ratio of the recorded and predicted total lung capacity (TLC) was shown to be signi®cantly higher than 0.85 (P 0:0002; Wilcoxon signed-rank test), indicating prevention of pulmonary restriction. Conclusion: Antero-lateral ¯ail chest injuries accompanied by respiratory insuf®ciency can be effectively stabilised using reconstruction plates. Early restoration of the chest wall integrity and respirator