Evidence map›Paper›PMID 39820681›Full record

ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2025

Biomechanics of flail chest injuries: tidal volume and respiratory work changes in multiple segmental rib fractures.

Julian N Zierke, Georg N Duda, Karl F Braun, Vera Jaecker, Ulrich Stöckle, Philipp Damm, Mark Heyland, Marcel Niemann

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Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

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2citing papers in PubMed
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1 · What the graph read from it

What it found

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2 · The registry

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3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

8 authors.

Julian N ZierkeJulius Wolff Institute, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Georg N DudaJulius Wolff Institute, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Karl F BraunDepartment of Trauma Surgery, University Hospital Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
Vera JaeckerCenter for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Ulrich StöckleCenter for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Philipp DammJulius Wolff Institute, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Mark HeylandJulius Wolff Institute, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. mark.heyland@bih-charite.de.
Marcel NiemannJulius Wolff Institute, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundFlail chest (FC) injuries are segmental osseous injuries of the thorax that typically result from high-energy blunt trauma and regularly occur in multiple trauma (MT) patients. FC injuries are associated with paradoxical chest wall movements and, thus, have a high risk of respiratory insufficiency or even death. An increasing number of studies recommend an early surgical stabilization of FC injuries, but a definite trigger that would indicate surgery has, thus far, not been identified.

methodsBased on real-world injury computed tomography (CT) data, this study aimed to establish a finite elements (FE) model of a thorax simulating spontaneous breathing. The model is based on a 0.625 mm slice thickness CT data set. In this FE model, various FC injury patterns were implemented to examine the impact of an increasingly large flail segment on tidal volume and respiratory work. The impact of the segmental defect sizes on the outcome measures mentioned above was examined using correlation analyses.

resultsThe FE model in this study reliably simulated the spontaneous breathing patterns of an actively breathing patient in an uninjured setting as a reference and showed clinically realistic movements of the flail segments for various injury settings. Correlation analysis showed a significant negative correlation between the FC size and tidal volume (R

conclusionThis study presents an FE model of the thorax of a patient who presented to our clinic as an MT patient with an FC injury. The FE model fulfills physiologic active breathing patterns and simulates an FC injury's paradoxical movement, realistically depicting clinical observations. The FE model showed that the number of consecutive ribs involved in the flail segment and the length of the flail segment significantly impacted active breathing concerning tidal volumes and respiratory work. With this, we have made the first step to define a trigger for surgery.

Indexed as

Flail ChestRib FracturesTidal VolumeAdultBiomechanical PhenomenaFinite Element AnalysisHumansMaleTomography, X-Ray ComputedWounds, NonpenetratingFinite element modelMultiple traumaParadoxical chest wall movementPulmonary functionRespiratory insufficiencyRib fracturesSurgical stabilization of rib fractures

Identifiers

PMID39820681
PMCPMC11742335

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