Management of Flail Chest: Outcome of Surgical Fixation versus Traditional Conservative Management

Background: High-impact chest trauma frequently results in rib fractures. It may cause severe respiratory compromise. Surgical management of flail chest has been used for a long time, but till now there is debate regarding its wide use and the optimal management remains controversial. Objective: This study aimed to compare the outcome of conservative versus surgical management of flail chest cases. Patients and methods: prospective multicenter cohort study included 48 patients with flail chest through the period from June 2020 to June 2023. Patients were divided into 2 groups: Group one (conservative management) included 27 patients and group two (surgical fixation) included 21 patients. Demographic and clinical data for all patients were collected and their outcome was compared. Results: Road traffic accident (RTA) was the most common cause of flail chest in both groups (51.85% in group one and 52.38% in group two) with no significant difference between both groups. There was a significantly shorter duration of mechanical ventilation (MV) in group two (P=0.044). ICU and hospital stay were also significantly less (P= 0.027and 0.013 respectively). Again, complications and chronic pain were less. Surgical correction was satisfactory with restored chest wall symmetry in 20 patients (95.24%) which was significantly higher than 16 patients in the conservative group (59.26%). Conclusion: Surgical fixation of flail chest was safe, effective and had better outcome than conservative management. Also, it was associated with shorter ventilation duration and ICU and hospital stay with less morbidity, pulmonary complications and postoperative chronic pain. This study can be considered as added evidence to the body of knowledge regarding management of flail chest.