Grant: Operating Grant

Major trauma to the chest from a motor vehicle accident or fall can result in multiple fractured ribs and severe instability of the chest wall. This instability can significantly impair the mechanics of breathing and is termed a "flail chest". Patients who sustain a flail chest injury have substantial rates of death (over 30%) and prolonged pain and suffering. These patients can often require mechanical ventilation for days/weeks and suffer high rates of pneumonia, systemic infection, and extended stays in the intensive care unit (ICU). In addition, these patients often report long term problems with breathing function and chronic chest pain. The current standard of care for the treatment of flail chest injuries involves non-surgical management with supportive measures. Recently, in an attempt to improve outcomes several investigators have studied the use of surgical methods to fix the multiple rib fractures and stabilize the chest wall in patients with these injuries. Several recent, small studies have suggested that surgical fixation may result in improved outcomes for these patients. Unfortunately, the studies conducted to date have had small numbers of patients, involved single centres, and have used inconsistent surgical methods. Our goal is to compare surgical fixation of flail chest injuries with non-surgical management in a large scale trial involving multiple trauma centres across Canada. The aim is to compare outcomes of the two treatments, with our most important result being the number of days a patient requires mechanical ventilation. We hypothesize that surgical fixation will result in improved patient outcomes over conventional non-surgical management. This study has the potential for global impact across the many health disciplines that care for patients with flail chest injuries and will likely lead to improved treatments and outcomes in these severely injured trauma patients.