Surgical stabilization of severe flail chest with Judet and Sanchez-Lloret plates. A case report

INTRODUCTION: Flail chest is now usually treated by conservative methods and surgical fixation remainsindicated in selected cases. Different techniques can be used for fixation. The aim of this paper is topresent a case in which Judet and Sanchez-Loret plates were employed and to discuss the usefulness ofthis traditional technique.PRESENTATION OF CASE: A 79-year-old woman was admitted for left thoracic trauma with severe antero-lateral flail chest. She was affected by COPD with chronic respiratory failure, ischemic heart disease,autoimmune thrombocytopenia treated on chronic steroid therapy and severe osteoporosis. CT-scandetected multiple rib fractures, left hemothorax and lung contusions. An initial conservative treatmentof flail chest involved compressive bandage and then internal pneumatic stabilization in ICU, but it failed.The patient underwent successful surgical treatment of the flail chest by fixation of the anterior fracturesfrom the second to the eight rib. Judet and Sanchez-Lloret plates were used. A bilateral pneumoniadeveloped during the rehabilitation period and the patient died two months after operation.DISCUSSION: Judet and Sanchez-Lloret plates represent a traditional technique for fixation of flail chest.This technique is less and less used and progressively replaced by newer materials, especially titaniumplates with screws or intramedullary struts. Our patient had multiple comorbidities and a very fragilebones that advised against use of screws or intramedullary struts.CONCLUSION: Judet and Sanchez-Lloret plates can be still considered a useful tool for the fixation of flailchest in cases of thin and fragile bones.