Outcomes of internal rib fixation through complete video-assisted thoracoscopic surgery for multiple rib fractures and flail chest in severe chest trauma.

Background: Surgical stabilization of rib fractures (SSRF) is a standard treatment for multiple rib fractures and flail chest. The aim of this study is to evaluate the outcomes of internal rib fixation through complete video-assisted thoracoscopic surgery (VATS) for multiple rib fractures and flail chest in patients with severe chest trauma.

Methods: Thirty-nine patients with multiple rib fractures caused by severe chest trauma were divided into two groups according to the surgical approach used. Twenty-one patients were diagnosed with flail chest. In the thoracoscopic surgery group, 17 patients underwent internal rib fixation through complete VATS. In the open surgery group, 22 patients underwent surgery with open reduction and internal fixation. Surgical variables, such as operation time, intraoperative blood loss, chest tube drainage volume, complications, visual analog scale (VAS) of pain score, postoperative ventilator days, Intensive Care Unit (ICU) stay and hospital stay, were compared between the two groups.

Results: There were no differences in operation time, intraoperative blood loss, chest tube drainage volume, postoperative ventilator days, ICU stay or hospital stay between the two groups (P > 0.05). Although there was no significant difference in overall postoperative complications (P = 0.358), the incidence of postoperative pleural effusion was lower in the thoracoscopic surgery group than in the open surgery group (P = 0.025). The VAS score in the thoracoscopic surgery group was also significantly lower than that in the open surgery group on the seventh day after surgery (P = 0.014).

Conclusions: Internal rib fixation through complete VATS is a feasible and safe approach for treating multiple rib fractures and flail chest in patients with severe chest trauma.