Keywords
Flail chest
Surgical fixation
Thoracic Trauma Severity Score
Modified Shock Index
How to Cite
Abstract
Background: Anterior (stove-in) chest injury is a very rare but serious cause of chest wall instability. This study looked at how internal pneumatic stabilization compares to primary surgical fixation in patients with isolated blunt chest trauma.
Methods: We reviewed three cases treated at two trauma centers from January 2000 to January 2026. We used the Thoracic Trauma Severity Score (TTSS) and the Modified Shock Index (MSI) to assess severity. All patients were treated following ATLS guidelines, and management depended on injury severity, patient stability, and available resources. We compared outcomes between internal pneumatic stabilization (mechanical ventilation with PEEP) and open reduction with internal fixation (plates and screws).
Results: In the third case, early open reduction and internal fixation of both rib fractures and a transverse sternal fracture allowed the patient to return to normal activity sooner and leave the ICU by the third day after surgery. These results suggest that clinicians should review their treatment protocols for anterior flail chest and consider early surgical stabilization.
Conclusion: Internal pneumatic stabilization is a useful conservative treatment for anterior flail chest injury, but the small number of cases and the study’s retrospective design limit how much we can conclude. In this series, patients who had early open surgical fixation needed fewer days on a ventilator, spent less time in the ICU, and had fewer ventilator-related complications than those treated with internal pneumatic stabilization.
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