Christopher Michael R Satur*, Manikandar Srinivas Cheruvu, Rachel J Chubsey
Objective: Severity of chest wall trauma, commonly defined by the number of fractured ribs, fails to provide adequate definition of injuries. We describe an anatomical classification of flail chest and evaluate its predictive in comparison numerical and injury score characterisation.
Methods: Between September 2014 and December 2019, 156 (12.0%) of patients with major thoracic trauma, aged 57.6 years (SD 15.5) and 109 (69.9%) male, underwent surgical treatment chest wall injuries. We classified injuries according to our institutional classification of flail chest patterns, Types A-D or non-flail, to describe regional patterns of injury. The capacity to predict clinical outcome was compared to abbreviated injury scores and the new injury severity score.
Results: Flail chest constituted 77.3% of the population, Types A, B, C and D 19.5%, 26.6%, 24.7% 6.5% respectively. Road Traffic Collision (RTC) was the mechanism of injury in 71 (46.7%) and primarily caused types A and D injuries, whilst falls caused 62 (40.8%) of injuries, primarily types B and C, p<0.001. The severity of chest wall injury was not distinguished by Abbreviated injury scores AIS Chest or AIS Rib. Type A flail chest was however associated with most severe total injuries and had greatest demand for ventilation and critical care, p<0.01. The mortality of the population following treatment was 6 (3.85%).
Conclusion: The classification delineates patterns of major chest wall injury that reflect the patho-physiology of major chest wall trauma. The classification provides a structure by which surgical treatment may be planned. We commend the utility of the classification to management of major chest wall trauma.
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