Introduction, Epidemiology, and Definition of Chest Wall Injuries

Abstract

The modern treatment of traumatic disruption of the chest wall is a rapidly evolving field, with the development of newer techniques for analgesia, the refinement of the various aspects of mechanical ventilation, and the increasing interest in surgical stabilization of chest wall injuries. To the surgeon with an interest in trauma, it makes intuitive sense that, consistent with the stabilization of other fractures, the correction of deformity and fixation of unstable chest wall injuries would provide significant clinical advantages for the polytrauma patient. However, as with other innovations in the trauma field, unexpected or previously unknown complications inevitably occur and must be dealt with, and the rush to embrace a new technique(s) must be tempered with some caution. While it is probable that a specific subgroup of patients with chest wall injury will benefit from operative fixation, there are a number of aspects of this topic that are, at present, unclear. For example, with regard to rib fracture fixation, the indications, contraindications, and optimal implants remain somewhat controversial. In addition, even the choice of who should be performing the surgery can be unclear: orthopedic surgeons, trauma surgeons, and thoracic surgeons all have skills in this area. This chapter will discuss some of these issues in order to introduce the topic to the reader and define parameters relevant to this topic.