Operative, nonoperative treatment of unstable chest wall injuries yield similar outcomes
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According to results presented at the Orthopaedic Trauma Association Annual Meeting, there is no difference in general health outcomes at 1 year between patients treated operatively vs. nonoperatively for unstable chest wall injuries.
“Unstable chest wall injuries, or flail chest injuries, are associated with a high rate of morbidity and mortality, and while these have been historically treated nonoperatively, there is recent increase in interest in surgical fixation of these injuries,” Niloofar Dehghan, MD, FRCSC, interim chief of trauma at The CORE Institute, said in her presentation at the meeting, which was held as a virtual event.
Dehghan and colleagues analyzed 207 patients with flail chest injury defined as three or more segmental rib fractures, a significant deformity or instability of the chest wall. Researchers randomly assigned 99 patients to nonoperative management and 108 patients to open reduction and plate fixation.
According to the study, the primary outcome was general health, assessed by SF-36 scores at 1 week, 2 weeks, 6 weeks, 3 months, 6 months and 1 year after intervention. Researchers calculated physical component summary (PCS) and mental component summary (MCS) scores from SF-36 scores.
Dehghan and colleagues found similar PCS and MCS scores for both treatment groups. In the operative group, mean PCS score at 1 year was 42.1 and mean MCS score at 1 year was 46.3. Likewise, in the nonoperative group, mean PCS score was 41.3 and mean MCS score was 46.8.
After performing regression analysis, researchers found smoking was a predictor for both lower PCS and MCS scores. Additionally, patients who sustained a hemothorax or spent longer in the ICU had lower PCS scores.
“In conclusion, we found no difference in general health outcome scores in patients who were treated operatively or nonoperatively in this randomized controlled trial of unstable chest wall injuries,” Dehghan added.
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Dehghan N, et al. General outcomes for operative versus nonoperative treatment of acute, unstable chest wall injuries: Results from a previous randomized controlled trial. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 20-24, 2020 (virtual meeting).
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