Pii: S1010-7940(01)00818-1

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 …n ˆ 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 ˆ 0:04 and P ˆ 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 ˆ 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 respiratory pump function may be cost effective through the prevention of prolonged mechanical ventilation and restriction-related working incapacity. q 2001 Elsevier Science B.V. All rights reserved.