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Sat Jan 31 14:59:35 GMT 2009

Trouble is, there is a randomised trial showing efficacy.  Its relatively
small, but shows a potential positive effect for the intervention.  Further,
there are no RCTs which show it doesn't work / does harm.  Now, I don't
think we should accept a single small trial as gospel.  But we should
attempt to do the definitive trial.
K

J Trauma. 2002 Apr;52(4):727-32; discussion 732. Links
Surgical stabilization of internal pneumatic stabilization? A prospective
randomized study of management of severe flail chest patients.

Tanaka H, Yukioka T, Yamaguti Y, Shimizu S, Goto H, Matsuda H, Shimazaki S.
Department of Traumatology and Critical Care Medicine, Kyorin University,
Tokyo, Japan. htanaka at gol.com
BACKGROUND: We compared the clinical efficacy of surgical stabilization and
internal pneumatic stabilization in severe flail chest patients who required
prolonged ventilatory support. METHODS: Thirty-seven consecutive severe
flail chest patients who required mechanical ventilation were enrolled in
this study. All the patients received identical respiratory management,
including end-tracheal intubation, mechanical ventilation, continuous
epidural anesthesia, analgesia, bronchoscopic aspiration, postural drainage,
and pulmonary hygiene. At 5 days after injury, surgical stabilization with
Judet struts (S group, n = 18) or internal pneumatic stabilization (I group,
n = 19) was randomly assigned. Most respiratory management was identical
between the two groups except the surgical procedure. Statistical analysis
using two-way analysis of variance and Tukey's test was used to compare the
groups. RESULTS: Age, sex, Injury Severity Score, chest Abbreviated Injury
Score, number of rib fractures, severity of lung contusion, and Pao2/Fio2
ratio at admission were all equivalent in the two groups. The S group showed
a shorter ventilatory period (10.8 +/- 3.4 days) than the I group (18.3 +/-
7.4 days) (p < 0.05), shorter intensive care unit stay (S group, 16.5 +/-
7.4 days; I group, 26.8 +/- 13.2 days; p < 0.05), and lower incidence of
pneumonia (S group, 24%; I group, 77%; p < 0.05). Percent forced vital
capacity was higher in the S group at 1 month and thereafter (p < 0.05). The
percentage of patients who had returned to full-time employment at 6 months
was significantly higher in the S group (11 of 18) than in the I group (1 of
19). CONCLUSION: This study proved that in severe flail chest patients,
surgical stabilization using Judet struts has beneficial effects with
respect to less ventilatory support, lower incidence of pneumonia, shorter
trauma intensive care unit stay, and reduced medical cost than internal
fixation. Moreover, surgical stabilization with Judet struts improved
percent forced vital capacity from the early phase after surgical fixation.
Also, patients with surgical stabilization could return to their previous
employment quicker than those with internal pneumatic stabilization, even in
those with the same severity of flail chest. We therefore concluded that
surgical stabilization with Judet struts may be preferably applied to
patients with severe flail chest who need ventilator support.

2009/1/31 <KMATTOX at aol.com>

> Assuming your statement is scientifically sound I would use and teach  it.
> I have desperately looked for more than Class 5 data to support  their use
> (WAG).    There is now a long list of gadgets and  drugs that have been
> heavily
> marketed and later found to even be  harmful.    Everyone on this list has
> been
> and some even now are  guilty of continuing to use such fads.
>
> k
>
>
> In a message dated 1/31/2009 8:23:23 A.M. Central Standard Time,
> Krin135 at aol.com writes:
>
> if  indeed this new rib plate makes
> rib fixation without violating the  pleura practical thus  speeding return
> to
> physiological normal, at  what level of evidence will you  start
> using/teaching
> the  procedure?
>
>
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