Comparison of the Materials Used in Chest Wall Reconstruction for Flail Chest
Introduction: Flail chest is not uncommon following blunt chest trauma, and often it is complicated by respiratory insufficiency if it is not treated properly. Table 1 shows our strategy for the flail chest patients, which is based on the surgical intervention, according to the severity of the trauma. Our principle of surgical treatment for flail chest is to restore the continuity of fractured portions of the bony thorax, and to reconstruct the flail segment to the physiological chest wall. The comparison of the materials used in the chest wall reconstruction and the details of the operative procedures are shown in this video tape recording (VTR).
Materials and Discussion: Three kinds of materials were available: 1) Judet's titanium rib plates; 2) ceramic rib pins; and 3) titanium mini plates. These materials have been used to reconstruct the flail segments. These materials have been studied as to the easiness of operative procedure, stability, elasticity, and radioparency. The merits and demerits associated with the use of each of these materials are summarized in Table 2.
Table 1-Management of flail chest
Type Condition Treatment
I Mild flail chest with Conservative
mild intrathoracic injury
II Flail chest with mild Chest wall reconstruction
intrathoracic injury
III Flail chest with Lung Contusion IPPV
Chest wall reconstruction
at right time
IV Flail chest with intrathoracic Chest wall reconstruction
injury that required thoracotomy IPPV, if necessary
Table 2-Comparison of materials
Judet's Plate Ceramic Pin Titanium Plate
Surgical involvement Large Moderate Least
Stability Excellent Moderate Excellent
Elasticity Moderate Excellent Moderate
Radioparency Poor Good Relatively poor
Application Shaft Sternum Shaft Anywhere
Cartilage
As to the operative procedures, Ceramic rib pin and Titanium mare easy. On the other hand, about the stability of the reconstructed rib cage, Judet's plate and Titanium mini-plate are excellent with good stabilization.
For elasticity, the Ceramic rib pin seems to be the best of the three. And, it doesn't produce any detrimental effects on roentgenographic examinations.
Judet's plate and the titanium mini-plate have some effects on the x-ray findings, but it is much better than that of stainless materials.
Judet's plate can be applied only to rib shaft. The ceramic pin can be applied to sterno-costal fixation, and also can be applied to the cartilage. The titanium mini-plate can be applied to almost any place.
Conclusion: The most appropriate material should be chosen in the chest-wall reconstruction, according to the shape and the location of the fracture as shown in VTR.
Keywords: ceramin pin; chest wall reconstruction; flail chest; intrathoracic injury; Judet's plate; pulmonary contusion; titanium mini-plate; trauma
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