CT-lung volume estimates in trauma patients undergoing stabilizing surgery for flail chest

•This is the first-ever study of CT-lung volume estimates in trauma patients undergoing rib fracture stabilization.•Post-operative estimates of CT-lung volumes were significantly increased compared to pre-operative estimates.•Post-operative CT lung volumes strongly correlated to Forced Vital Capacity (FVC) and Total Lung Capacity (TLC).•CT lung volume can serve as a marker for lung function and provide the clinician with information to improve informed decision-making concerning surgery for rib fractures. To estimate and compare lung volumes from pre- and post-operative computed tomography (CT) images and correlate findings with post-operative lung function tests in trauma patients with flail chest undergoing stabilizing surgery. Pre- and post-operative CT images of the thorax were used to estimate lung volumes in 37 patients who had undergone rib plate fixation at least 6 months before inclusion for flail chest due to blunt thoracic trauma. Computed tomography lung volumes were estimated from airway distal to each lung hilum by outlining air-filled lung tissue either manually in images of 5 mm slice thickness or automatically in images of 0.6 mm slice thickness. Demographics, pain, range of motion in the thorax, breathing movements and Forced Vital Capacity (FVC) were assessed. Total Lung Capacity (TLC) measurements were also made in a subgroup of patients (n = 17) who had not been intubated at time of the initial CT. Post-operative CT lung volumes were correlated to FVC and TLC. Patients with a median age of 62 (19–90) years, a median Injury Severity Score (ISS) of 20 (9–54), and a median New Injury Severity Score (NISS) of 27 (17–66) were enrolled in the study. Median follow-up time was 3.9 (0.5–5.6) years. Two patients complained of pain at rest and when breathing. Pre-operative CT lung volumes were significantly different (p