The selection of surgical approach in the surgery of multiple rib fractures and flail chest


In the surgery of severe thoracic trauma the achievement of stabilization of the chest is one of the key factors that ensure a
positive treatment outcome. Operative fixation of fractures is a safe and effective method of stabilization, however, many technologies
require clarification, evaluation and improvement of approaches, including in the choice of surgical approach.
The purpose of the study
Choice of optimal approach for making ribs osteosynthesis at injured people with severe closed thorax
Materials and methods
The article describes the experience of surgical treatment of 75 patients with multiple rib fractures and flail
chest. All patients underwent osteosynthesis of the ribs with use of "Matrix Rib" technology. The patients had been selected on 2
groups: I group – 36 patients at whom operative access was performed through incision of soft tissue along intercostal spaces; II
group – 39 patients at whom alternative and improved options for surgical access had been used. We used the new technical devices,
contributing to the improvement of surgical techniques of rib fractures: a grid for marking the surgical field, trocar, two-channel
thoracoport for single-port thoracoscopy.
Results and their discussion
The estimation of different types of accesses was made. Also, their quantitative and qualitative
characteristics were indicated. There was no statistically significant influence of the type of surgical access on morbidity and
mortality. At patients of II group the reduction in the length of the surgical access incision, shorter operation, no need for additional
accesses had been achieved.
Surgical access which is performed in the projection of the lines of rib fractures suspected for restoration creates best
conditions to perform osteosynthesis. The use of special tools enables you to perform operative fixation of bone fragments of ribs
through a mini-invasive approaches, and conduct thoracoscopy to eliminate intrapleural damage.
Key words
Rib fracture, surgical approach, osteosynthesis

Samara state medical university, Chapaevskaya str.,89, Samara, 443099,Russian Federation

Author for correspondence.
д.м.н., проф., зав. кафедрой хирургии Самарского государственного медицинского университета;

Samara regional clinical hospital, Tashkentskaya str., 159, Samara, 443095, Russian Federatio

к.м.н., зав. хирургическим торакальным отделением Самарской областной клинической больницей им. М.И.Калинина

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