Intrathoracic rib fixation in flail chest: first South American experience.

Intrathoracic rib fixation represents a technical innovation with advantages over traditional methods through minimally invasive approach. We present the first South American case in a 21-year-old patient with flail chest from polytrauma. Four intrathoracic fixation plates (two 90 mm anterior and two 60 mm posterior) were used through video-assisted anterolateral and posterior approaches. The technique facilitates reduction through guide cables, intrathoracic positioning with minimal muscular disruption and automatic adaptation to costal anatomy. Total surgical time was 155 minutes with 250 mL bleeding. Immediate resolution of paradoxical movement, ventilatory weaning at three postoperative days and discharge with no respiratory sequelae were achieved. Controls confirmed stable implant position without complications. This technique proved feasible, safe and effective, representing a superior alternative for flail chest stabilisation with optimised functional outcomes.