Surgical stabilization of rib fractures in patients with open flail chest results in improved clinical outcomes: a report of three cases

Background: Open flail chest is a rare but life-threatening condition characterized by severe chest wall instability and contaminated wounds, which increase the risk of postoperative hardware infection. Surgical stabilization of rib fractures (SSRF) has shown benefits in blunt thoracic trauma; however, its application in open flail chest remains controversial due to infection concerns. Evidence guiding the decision to perform SSRF in this setting is limited.

Case Description: We retrospectively analyzed three patients with open flail chest who underwent SSRF. Clinical data were collected, including demographics, injury characteristics, surgical management, postoperative recovery, and long-term outcomes. All patients underwent timely debridement and internal fixation. Postoperatively, all patients showed favorable recovery with restoration of chest wall stability. No hardware-related infections or chest wall deformities were observed during follow-up periods of 19, 72, and 122 months.

Conclusions: For selected patients with open flail chest, when the time from injury to surgery is no more than 8 hours, the open wound contamination is mild, and thorough debridement is performed, chest wall reconstruction and internal fixation surgery may be relatively safe. This approach can help save patients’ lives in the early stage and may lead to favorable long-term outcomes. However, caution should be exercised when considering primary surgery for patients with open contaminated wounds and an injury-to-surgery time exceeding 8 hours. Admittedly, our conclusions need to be validated with more cases.