Indication for SSRF were major rib fracture displacement (at least one bicortical displaced rib) with chest wall deformation and/or ongoing pain and/or mobile flail chest and/or hemothorax >200 mL/hour and/or suspicion of diaphragmatic laceration. Patient surgery positioning was adapted to injury localization as well as extra thoracic injuries such as spine trauma and pelvic or limb fractures. The posterolateral approach was preferably used for rib fractures of the lateral and posterior chest wall, whereas the anterior approach was used for anterior chest wall disruption or for patients with spine injuries or other injuries requiring strict supine positioning. SSRF was preferentially performed on fractures of the 3rd to the 9th ribs using the MatrixRibTM system (DePuy Synthes, Johnson & Johnson, USA) with plates and intra-medullary splints. The procedure did not evolve over this 10-years period and was standardized as follows: patients were under general anesthesia with double lumen endotracheal tube. Skin incisions were centered on the lesions; muscles were incised in the fiber axes or were mobilized without division whenever feasible. After exposure of rib fractures without opening the chest wall, an intercostal trocar was inserted to perform a video thoracoscopic exploration to manage clot removal and to identify any diaphragmatic laceration or rupture. Diaphragmatic repair was performed by a video thoracoscopic approach if possible or after a thoracotomy conversion using non-resorbable stitches with Teflon patches. Universal plates were preferably used to fix flail chest or multiple rib fractures with 3 screws on each side as recommended. The intramedullary splints were preferably used in patient requiring surgery in the supine position to fix lateral and posterior fractures by an anterior approach (trap door incisions). At the end of the procedure, the chest wall cavity was washed with 2–3 liters of 37 ℃ isotonic saline solution; a 24 Fr chest drain was inserted and placed at −20 mmHg suction. All patients were finally referred to an ICU for post-operative monitoring.
We defined time from hospital admission to surgery in three groups using cutoffs already chosen in the literature (20 (link),21 (link)): early surgery (within 48 h after admission), mid (from 48 hours to 7 days) and late surgery (after 7 days). Complete patient main characteristic data and circumstances of injuries were collected using emergency unit reports. Numerous data were prospectively recorded such as chest wall fracture characterization with 3D CT scan reconstruction, length of mechanical ventilation, length of ICU and hospital stay; Home discharge or rehabilitation centers, pulmonary morbidity and overall mortality. The Chest Trauma Score (CTS) (22 (link)), the Injury Severity Score (ISS) and the new Simplified Acute Physiology Score (SAPS II) (23 ) were calculated to gather physiologic and clinical data.
We defined time from hospital admission to surgery in three groups using cutoffs already chosen in the literature (20 (link),21 (link)): early surgery (within 48 h after admission), mid (from 48 hours to 7 days) and late surgery (after 7 days). Complete patient main characteristic data and circumstances of injuries were collected using emergency unit reports. Numerous data were prospectively recorded such as chest wall fracture characterization with 3D CT scan reconstruction, length of mechanical ventilation, length of ICU and hospital stay; Home discharge or rehabilitation centers, pulmonary morbidity and overall mortality. The Chest Trauma Score (CTS) (22 (link)), the Injury Severity Score (ISS) and the new Simplified Acute Physiology Score (SAPS II) (23 ) were calculated to gather physiologic and clinical data.
