Crushed Chest With Operative Exposure for Rib Stabilization

An adult patient is brought to the trauma center after a high-energy motor-vehicle collision with a crushed chest. Initial assessment shows respiratory failure, paradoxical chest-wall motion, severe chest pain before sedation, and hypoxemia. The patient is intubated, mechanically ventilated, and admitted to the trauma ICU. After initial resuscitation, CT chest demonstrates multiple markedly displaced fractures involving several contiguous ribs with a flail segment and pulmonary contusions; no injury requiring emergent abdominal surgery is identified. The patient remains hemodynamically suitable for further evaluation and planned intervention. Despite lung-protective ventilation, analgesia, pulmonary toilet, and supportive care, chest-wall instability and ventilator dependence persist. On the following hospital day, the patient is taken to the operating room for planned rib stabilization. After induction, positioning, and open exposure of the injured chest wall, the teaching image is obtained before fixation is completed.