Impact of Surgical Stabilization of Flail Chest Injuries on Postoperative Computed Tomography Lung Volumes

Moses K D El Kayali; Georg Böning; Moritz Günther Mewes; Karl F Braun; Karin Steinecke; Konrad Neumann; Ulrich Stöckle; Vera Jaecker; Marcel Niemann

doi:10.3390/jcm14113644

Impact of Surgical Stabilization of Flail Chest Injuries on Postoperative Computed Tomography Lung Volumes

J Clin Med. 2025 May 22;14(11):3644. doi: 10.3390/jcm14113644.

Authors

Moses K D El Kayali¹, Georg Böning², Moritz Günther Mewes¹, Karl F Braun³, Karin Steinecke⁴, Konrad Neumann⁵, Ulrich Stöckle¹, Vera Jaecker¹, Marcel Niemann^{1

6}

Affiliations

¹ Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
² Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
³ Department of Trauma Surgery, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany.
⁴ Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
⁵ Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
⁶ Julius Wolff Institute, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.

Abstract

Background: Flail chest (FC) injuries are multiple adjacent segmental rib fractures, commonly associated with a high complication and mortality risk. Recent evidence suggests that the early surgical stabilization of FC injuries is beneficial for restoring breathing mechanics. However, little is known about the effects on lung volumes when invasive ventilation is performed after surgery. Methods: This retrospective study included multiple trauma (MT) patients operatively treated for an FC injury between 2011 and 2024. The indication for surgery was based on a computed tomography (CT) proof of an FC, objectifiable paradoxical breathing, and prolonged weaning. All patients treated used a single osteosynthesis system. Lung volumes were manually measured in preoperative and postoperative CT scans of the thorax in the thinnest CT reconstructions available. The primary outcomes of interest were the changes in the lung volumes following surgical stabilization of the FC. Results: During this study, 21 patients (90.48% male) were operatively treated for their FC injury. All patients had been affected by high-energy trauma. The corresponding median Injury Severity Score (ISS) was 26 (IQR 17.5, 33). Patients suffered 7 (IQR 6, 10) and 6 (IQR 2, 9) fractured ribs of the left and right hemithorax, respectively. Three (IQR 0, 3) and two (IQR 0, 3) ribs of the left and right hemithorax, respectively, were stabilized at 7 (IQR 2, 18) days post admission. There were no significant changes in the lung volumes comparing preoperative and postoperative CT scans. Conclusions: As this study did not detect CT volume changes comparing preoperative and postoperative scans, CT scans following surgery may not qualify for an objective measurement of the surgical effectiveness regarding lung volume restoration in the short-term follow-up. Long-term changes in CT-measured lung volume changes need to be evaluated to prove an objective surrogate parameter for surgical effectiveness regarding the restoration of the thorax integrity.

Keywords: flail chest; multiple trauma; osteosynthesis; thorax stabilization; unstable thorax.