The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Insertion of metal rib reinforcements to stabilise a flail chest wall.

Description

The condition in which multiple rib fractures allow a segment of the rib cage to move independently from the main chest wall is called a flail chest. The effect compromises breathing and may be life-threatening.

In this procedure, metal (usually titanium) is used to stabilise the ‘flail’ segment of chest wall. This procedure aims to improve lung function and reduce the length of critical care and hospital stay.

Coding recommendations

The following OPCS-4 codes are available:

W19.8 Other specified primary open reduction of fracture of bone and intramedullary fixation

W19.9 Unspecified primary open reduction of fracture of bone and intramedullary fixation

W20.1 Primary open reduction of fracture of long bone and extramedullary fixation using plate NEC

W20.6 Wiring of sternum

W20.8 Other specified primary open reduction of fracture of bone and extramedullary fixation

W20.9 Unspecified primary open reduction of fracture of bone and extramedullary fixation

The following site codes can be added to identify which ribs are involved:

Z74.3 First rib

Z74.4 Second to tenth rib

Z74.5 Eleventh or twelfth rib

Z74.6 Rib NEC

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)