Management of severe chest wall trauma

Injuries to the chest wall remain common and are attributable for 20–25% of all trauma deaths. In the most severe forms of chest trauma derangements of oxygenation and ventilation, severe inflammatory response, musculoskeletal structural compromise, aspiration and subsequent pneumonia often result from the physiologic insult. In addition, this severe complex of injury is often not in isolation and may be compounded with traumatic brain injury, cervical and thoracic spinal fractures, long bone injury and solid organ injuries. Since the first description of thoracic injury management in 3000 BC, chest wall trauma has proven to be a challenge to clinicians for millennia. The goal of this review article is to review contemporary management and options for severe blunt chest trauma. We will review operative and non-operative management, discuss the principles of chest wall fixation as well as elucidate strategies for respiratory support both with mechanical ventilation and extracorporeal assistance.