Surgical management of multiple rib fractures/flail chest

Twenty percent of patients presenting following trauma have thoracic injuries (1). Thoracic injury contributes to 25% of the death seen in trauma patients (2). This includes those with aortic transection, 85% of whom do not make it to the hospital (3). For the remaining the mortality is 10% of which 56% is within the first 24 hours (4). Mortality in the elderly population with multiple rib fractures has been quoted as high as 22% (5). Fifty-five percent of patients, greater than 60 years of age, who die following chest trauma, have isolated rib fractures (6). The risk of mortality, from rib fractures, in relation to age has been shown to increase from the age of 45 (7). It is important, however, to note that 33% of patients with thoracic injuries will have injuries outside the thoracic cavity (8). Thus, appropriate clinical assessment and investigations are key within the emergency department and subsequently on the wards