<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1405-0099</journal-id>
<journal-title><![CDATA[Cirujano general]]></journal-title>
<abbrev-journal-title><![CDATA[Cir. gen]]></abbrev-journal-title>
<issn>1405-0099</issn>
<publisher>
<publisher-name><![CDATA[Asociación Mexicana de Cirugía General A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1405-00992017000400237</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Tratamiento quirúrgico del tórax inestable. ¿Dónde nos encontramos? Experiencia de un hospital privado]]></article-title>
<article-title xml:lang="en"><![CDATA[Surgical treatment of the unstable thorax. Where do we stand? A private hospital experience]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Luna-Tovar]]></surname>
<given-names><![CDATA[Agustín]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez Luna]]></surname>
<given-names><![CDATA[María Rita]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Morales Villalobos]]></surname>
<given-names><![CDATA[Rodrigo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Noriega Usi]]></surname>
<given-names><![CDATA[Víctor Manuel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Ángeles Mocel  ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital Ángeles Mocel  ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2017</year>
</pub-date>
<volume>39</volume>
<numero>4</numero>
<fpage>237</fpage>
<lpage>246</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S1405-00992017000400237&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S1405-00992017000400237&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S1405-00992017000400237&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción:  El trauma de tórax tiene implicaciones serias; representa el 20% de las muertes por trauma. El tórax inestable (TI), resultado de múltiples segmentos costales fracturados, agrava el problema y es responsable de una elevada morbilidad y mortalidad. Durante los últimos años, los pacientes se trataban con manejo del dolor y, en caso de requerirlo, estabilización neumática interna. En 1998, Tanaka y sus colaboradores compararon de forma prospectiva dicho manejo contra la estabilización quirúrgica; desde entonces, la evidencia científica ha mostrado resultados más favorables en pacientes que se someten a reducción abierta y fijación interna: se reduce la morbimortalidad, los días de estancia intrahospitalaria (EIH), los días de terapia intensiva con necesidad de ventilación mecánica y mejoran los resultados a largo plazo. Desde 2001, nuestro grupo inició la fijación de fracturas costales en pacientes con TI.  Material y métodos:  Este artículo muestra las distintas opciones que se han tenido para la estabilización quirúrgica a lo largo de los años; se presentan 11 casos de pacientes con diagnóstico de tórax inestable (TI), quienes fueron sometidos a manejo quirúrgico con fijación interna (RAFI) mediante sutura de alambre, sistemas de osteosíntesis maxilofacial y, en los últimos casos, dispositivos de titanio para fijación de fracturas como StraCos®.  Resultados: En 16 años, 10 pacientes presentaron trauma torácico cerrado y uno trauma torácico penetrante. Los pacientes tuvieron ISS promedio de 30.2 (DE =14.39). La media de EIH fue de 21.8 días (DE = 11.14). La media de días de estancia en la unidad de cuidados intensivos (DEUCI) fue de 8.9 días (DE = 4.89). El número de fracturas costales fijadas (NFCF) y los DEUCI mostraron una correlación negativa importante, r (12) = -0.624, p = 0.039. A su vez, el NFC y los días en ventilación mecánica también mostraron una correlación negativa importante, r (12) = -0.698, p = 0.015, con el NFCF explicando el 48.7% de la variación encontrada en los días en ventilación mecánica (DVM). Se realizó una prueba t de muestra única analizando nuestros valores de DVM (m = 6.45, DE = 4.61) contra los reportados en la literatura, sin encontrar diferencia significativa, t (10) = 1.837, p = 0.096. El número de fracturas costales tratadas con fijación quirúrgica en los pacientes se asoció con una menor estancia en terapia intensiva y menos días de ventilación mecánica. Esta disminución no se encontró relacionada con los traumatismos agregados y procedimientos quirúrgicos de urgencia a los que se sometieron dichos pacientes.  Conclusiones:  La fijación quirúrgica de fracturas costales mostró un beneficio significativo en la evolución clínica de los pacientes presentados.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  Thoracic trauma has serious implications, accounting for 20% of all trauma deaths. Flail chest resulting from multiple rib fractures aggravates the problem and is responsible for significant morbidity and mortality. Initially, these patients were treated with pain management, and internal pneumatic stabilization when needed. In 1998, Tanaka and his group were the first to evaluate the differences between this management and surgical management with open reduction and internal fixation; since then, evidence has shown better outcomes with the surgical treatment, with a shorter hospital length of stay, less length of stay in the ICU with mechanical ventilation and better results. In 2001, our surgical team began the use of surgical rib fixation in patients with flail chest.  Material and methods:  This article evaluates the different surgical options for open reduction-internal fixation (ORIF) throughout time. We present 11 cases with a flail chest diagnosis that had surgical management. Initially, we used wire sutures for approximation and surgical fixation, osteosyntheses with maxillofacial devices and, lately, titanium devices such as StraCos®.  Results:  During the past 16 years, ten patients presented to our hospital with closed thoracic trauma and one with penetrating trauma. The patients had a mean ISS of 30.2 (SD = 14.39). The mean hospital length of stay was 21.8 days (SD = 11.14). The mean of days in the intensive care unit (DICU) was 8.9 days (SD = 4.89). The number of rib fractures with internal fixation (NRFIF) and DICU showed an important negative correlation, r (12) = -0.624, p = 0.039. In turn, NRF and the days in mechanical ventilation (DMV) also showed an important negative correlation, r (12) = -0.698, p = 0.015, with the NRFIF explaining 48.7% of the variation found in the DMV. A single sample t test was performed, analyzing our DMV values (m = 6.45, SD = 4.61) against those reported in the literature, without finding significant difference, t (10) = 1.837, p = 0.096. The number of rib fractures treated with surgical fixation in patients was associated with a shorter stay in intensive care and less days of mechanical ventilation. This decrease was not found related to aggregated trauma and emergency surgical procedures that these patients underwent.  Conclusions:  Surgical fixation of rib fractures showed a significant benefit in the clinical outcome of patients presented.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Trauma de tórax]]></kwd>
<kwd lng="es"><![CDATA[fracturas costales]]></kwd>
<kwd lng="es"><![CDATA[tórax inestable]]></kwd>
<kwd lng="es"><![CDATA[fijación quirúrgica]]></kwd>
<kwd lng="es"><![CDATA[reconstrucción de la pared torácica]]></kwd>
<kwd lng="en"><![CDATA[Thoracic trauma]]></kwd>
<kwd lng="en"><![CDATA[rib fractures]]></kwd>
<kwd lng="en"><![CDATA[flail chest]]></kwd>
<kwd lng="en"><![CDATA[surgical fixation]]></kwd>
<kwd lng="en"><![CDATA[chest wall reconstruction]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pettiford]]></surname>
<given-names><![CDATA[BL]]></given-names>
</name>
<name>
<surname><![CDATA[Luketich]]></surname>
<given-names><![CDATA[JD]]></given-names>
</name>
<name>
<surname><![CDATA[Landreneau]]></surname>
<given-names><![CDATA[RJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The management of flail chest]]></article-title>
<source><![CDATA[Thorac Surg Clin]]></source>
<year>2007</year>
<volume>17</volume>
<page-range>25-33</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Miller]]></surname>
<given-names><![CDATA[LA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Chest wall, lung, and pleural space trauma]]></article-title>
<source><![CDATA[Radiol Clin North Am]]></source>
<year>2006</year>
<volume>44</volume>
<page-range>213-viii</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Fowler]]></surname>
<given-names><![CDATA[TT]]></given-names>
</name>
<name>
<surname><![CDATA[Taylor]]></surname>
<given-names><![CDATA[BC]]></given-names>
</name>
<name>
<surname><![CDATA[Bellino]]></surname>
<given-names><![CDATA[MJ]]></given-names>
</name>
<name>
<surname><![CDATA[Althausen]]></surname>
<given-names><![CDATA[PL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Surgical treatment of flail chest and rib fractures]]></article-title>
<source><![CDATA[J Am Acad Orthop Surg]]></source>
<year>2014</year>
<volume>22</volume>
<page-range>751-60</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bastos]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Calhoon]]></surname>
<given-names><![CDATA[JH]]></given-names>
</name>
<name>
<surname><![CDATA[Baisden]]></surname>
<given-names><![CDATA[CE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Flail chest and pulmonary contusion]]></article-title>
<source><![CDATA[Semin Thorac Cardiovasc Surg]]></source>
<year>2008</year>
<volume>20</volume>
<page-range>39-45</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Paydar]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Mousavi]]></surname>
<given-names><![CDATA[SM]]></given-names>
</name>
<name>
<surname><![CDATA[Niakan]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Abbasi]]></surname>
<given-names><![CDATA[HR]]></given-names>
</name>
<name>
<surname><![CDATA[Bolandparvaz]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Appropriate management of flail chest needs proper injury classification]]></article-title>
<source><![CDATA[J Am Coll Surg]]></source>
<year>2012</year>
<volume>215</volume>
<page-range>743-4</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[DeFreest]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Tafen]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Bhakta]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Ata]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Martone]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Glotzer]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Open reduction and internal fixation of rib fractures in polytrauma patients with flail chest]]></article-title>
<source><![CDATA[Am J Surg]]></source>
<year>2016</year>
<volume>211</volume>
<page-range>761-7</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sarani]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Schulte]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Diaz]]></surname>
<given-names><![CDATA[JJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Pitfalls associated with open reduction and internal fixation of fractured ribs]]></article-title>
<source><![CDATA[Injury]]></source>
<year>2015</year>
<volume>46</volume>
<page-range>2335-40</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Moreno-De La Santa Barajas]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Polo-Otero]]></surname>
<given-names><![CDATA[MD]]></given-names>
</name>
<name>
<surname><![CDATA[Delgado Sánchez-Gracián]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Lozano-Gómez]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Toscano-Novella]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Calatayud Moscoso-Del Prado]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Surgical fixation of rib fractures with clips and titanium bars (STRATOS System). Preliminary experience]]></article-title>
<source><![CDATA[Cir Esp]]></source>
<year>2010</year>
<volume>88</volume>
<page-range>180-6</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bemelman]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[van Baal]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Yuan]]></surname>
<given-names><![CDATA[JZ]]></given-names>
</name>
<name>
<surname><![CDATA[Leenen]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The role of minimally invasive plate osteosynthesis in rib fixation: a review]]></article-title>
<source><![CDATA[Korean J Thorac Cardiovasc Surg]]></source>
<year>2016</year>
<volume>49</volume>
<page-range>1-8</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Tanaka]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Yukioka]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Yamaguti]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Shimizu]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Goto]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Matsuda]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients]]></article-title>
<source><![CDATA[J Trauma]]></source>
<year>2002</year>
<volume>52</volume>
<page-range>727-32</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Leinicke]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Elmore]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Freeman]]></surname>
<given-names><![CDATA[BD]]></given-names>
</name>
<name>
<surname><![CDATA[Colditz]]></surname>
<given-names><![CDATA[GA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Operative management of rib fractures in the setting of flail chest: a systematic review and meta-analysis]]></article-title>
<source><![CDATA[Ann Surg]]></source>
<year>2013</year>
<volume>258</volume>
<page-range>914-21</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Jayle]]></surname>
<given-names><![CDATA[CP]]></given-names>
</name>
<name>
<surname><![CDATA[Allain]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Ingrand]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Laksiri]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Bonnin]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Hajj-Chahine]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Flail chest in polytraumatized patients: surgical fixation using Stracos reduces ventilator time and hospital stay]]></article-title>
<source><![CDATA[Biomed Res Int]]></source>
<year>2015</year>
<numero>2015</numero>
<issue>2015</issue>
<page-range>624723</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ahmed]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
<name>
<surname><![CDATA[Mohyuddin]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation]]></article-title>
<source><![CDATA[J Thorac Cardiovasc Surg]]></source>
<year>1995</year>
<volume>110</volume>
<page-range>1676-80</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lafferty]]></surname>
<given-names><![CDATA[PM]]></given-names>
</name>
<name>
<surname><![CDATA[Anavian]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Will]]></surname>
<given-names><![CDATA[RE]]></given-names>
</name>
<name>
<surname><![CDATA[Cole]]></surname>
<given-names><![CDATA[PA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Operative treatment of chest wall injuries: indications, technique, and outcomes]]></article-title>
<source><![CDATA[J Bone Joint Surg Am]]></source>
<year>2011</year>
<volume>93</volume>
<page-range>97-110</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Fitzpatrick]]></surname>
<given-names><![CDATA[DC]]></given-names>
</name>
<name>
<surname><![CDATA[Denard]]></surname>
<given-names><![CDATA[PJ]]></given-names>
</name>
<name>
<surname><![CDATA[Phelan]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Long]]></surname>
<given-names><![CDATA[WB]]></given-names>
</name>
<name>
<surname><![CDATA[Madey]]></surname>
<given-names><![CDATA[SM]]></given-names>
</name>
<name>
<surname><![CDATA[Bottlang]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Operative stabilization of flail chest injuries: review of literature and fixation options]]></article-title>
<source><![CDATA[Eur J Trauma Emerg Surg]]></source>
<year>2010</year>
<volume>36</volume>
<page-range>427-33</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[López-Bascopé]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Cambios históricos ó necesarios en la anestesiología actual]]></article-title>
<source><![CDATA[Anestesia en México]]></source>
<year>2009</year>
<volume>21</volume>
<page-range>86-8</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nirula]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Diaz]]></surname>
<given-names><![CDATA[JJ]]></given-names>
</name>
<name>
<surname><![CDATA[Trunkey]]></surname>
<given-names><![CDATA[DD]]></given-names>
</name>
<name>
<surname><![CDATA[Mayberry]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Rib fracture repair: indications, technical issues, and future directions]]></article-title>
<source><![CDATA[World J Surg]]></source>
<year>2009</year>
<volume>33</volume>
<page-range>14-22</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Velmahos]]></surname>
<given-names><![CDATA[GC]]></given-names>
</name>
<name>
<surname><![CDATA[Vassiliu]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Chan]]></surname>
<given-names><![CDATA[LS]]></given-names>
</name>
<name>
<surname><![CDATA[Murray]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Berne]]></surname>
<given-names><![CDATA[TV]]></given-names>
</name>
<name>
<surname><![CDATA[Demetriades]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Influence of flail chest on outcome among patients with severe thoracic cage trauma]]></article-title>
<source><![CDATA[Int Surg]]></source>
<year>2002</year>
<volume>87</volume>
<page-range>240-4</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Voggenreiter]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Neudeck]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Aufmkolk]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Obertacke]]></surname>
<given-names><![CDATA[U]]></given-names>
</name>
<name>
<surname><![CDATA[Schmit-Neuerburg]]></surname>
<given-names><![CDATA[KP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Operative chest wall stabilization in flail chest -outcomes of patients with or without pulmonary contusion]]></article-title>
<source><![CDATA[J Am Coll Surg]]></source>
<year>1998</year>
<volume>187</volume>
<page-range>130-8</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Tanaka]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Tajimi]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Endoh]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Kobayashi]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Pneumatic stabilization for flail chest injury: an 11-year study]]></article-title>
<source><![CDATA[Surg Today]]></source>
<year>2001</year>
<volume>31</volume>
<page-range>12-7</page-range></nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Karlo]]></surname>
<given-names><![CDATA[CA]]></given-names>
</name>
<name>
<surname><![CDATA[Stolzmann]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Do]]></surname>
<given-names><![CDATA[RK]]></given-names>
</name>
<name>
<surname><![CDATA[Alkadhi]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Computed tomography of the spleen: how to interpret the hypodense lesion]]></article-title>
<source><![CDATA[Insights Imaging]]></source>
<year>2013</year>
<volume>4</volume>
<page-range>65-76</page-range></nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Slobogean]]></surname>
<given-names><![CDATA[GP]]></given-names>
</name>
<name>
<surname><![CDATA[MacPherson]]></surname>
<given-names><![CDATA[CA]]></given-names>
</name>
<name>
<surname><![CDATA[Sun]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Pelletier]]></surname>
<given-names><![CDATA[ME]]></given-names>
</name>
<name>
<surname><![CDATA[Hameed]]></surname>
<given-names><![CDATA[SM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Surgical fixation vs. nonoperative management of flail chest: a meta-analysis]]></article-title>
<source><![CDATA[J Am Coll Surg]]></source>
<year>2013</year>
<volume>216</volume>
<page-range>302-11.e1</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
