To evaluate the surgical approaches and effectiveness of exploration, repair and homeochronous micro-invasive treatments of rib fractures for multiple fractured ribs with chest traumas through complete video-assisted thoracoscopic surgery (VATS).

The clinical data of 22 cases of multiple fractured ribs with chest traumas such as traumatic hemopneumothorax, open chest trauma, progressive hemothorax, flail chest, rupture of the diaphragm, and intrathoracic foreign body in our hospital from January 2016 to November 2018 were retrospectively analyzed.

Satisfactory effect of stabilization of chest wall were obtained in all the 22 patients with rib fractures using VATS exploration. We carried out exploration, hemostasis, lung-repair and diaphragm repair first, then dissected and exposed the broken end of ribs through operating holes without cutting off chest muscles, and selectively focused on stabilizing multi-fractures of ribs finally. No conversion to thoracotomy in this cohort. All the cases were successfully completed with the operation of rib fracture internal fixation under VATS, based on primary and/or auxiliary operating holes, except 3 cases with added longitudinal incision nearby spinal column. Delayed incision healing occurred in 3 cases and cured with systemic anti-biotics and local dressing changes. Pulmonary air leakage occurred in 1 case, and treated by closed drainage of thoracic cavity and chest tube was removed in 7 days. Follow up results showed reliable rib fixation and satisfactorily bony union. Intercostal neuralgia occurred in 1 case. Numbness of the chest occurred in 3 cases. Local pleural thickening occurred in 6 cases.

For chest trauma with fractures of multiple ribs, which satisfies the standards of thoracoscopic exploration, homochromous fixation of fractured ribs using exploratory incision of thoracoscope is safe and feasible. This procedure has advantage of rapid recovery and fewer complications, without adding extra injury.