Characteristics of thoracic trauma and traumatic thoracic deformity The external force in severe thoracic trauma destroys the intact mechanism of the chest wall, resulting in thoracic deformity, accompanied by pulmonary contusion, injury to thoracic or abdominal organs and hemopneumothorax. Paradoxical respiration can be caused by either a shackled chest or a sternal fracture. Paradoxical respiratory motion decreases bilateral lung ventilation, loss of physiological negative pressure in the chest, and pulmonary atelectasis occurs. As a result of decreased tidal volume, arteriovenous blood shunts in the lungs and the alveolar-arterial oxygen difference increases, creating severe hypoxemia. It is thought that hypoxemia is due to the occurrence of paradoxical respiration followed by turbulence of intrapulmonary gases in the left and right lungs, which cannot be effectively exchanged with extra-pulmonary gases causing carbon dioxide retention, and hypoxic hypercapnia is called the turbulent gas theory. In addition, paradoxical respiration can aggravate lung injury, make a large amount of liquid protein and intracellular material from deep into the interstitial space and alveoli, form pulmonary edema, reduce lung compliance, increase airway resistance, accumulate airway secretions, reduce gas diffusion, decrease blood oxygen saturation, and make the disease develop into ARDS. Therefore, paradoxical breathing is one of the main factors of early death in thoracic trauma, and its mortality rate can reach 20%-30%. In the rescue and treatment process of thoracic trauma, early correction and limitation of paradoxical breathing is often the key link to reduce mortality and improve quality of life. As the awareness of the harm of paradoxical breathing gradually deepens, so the control of paradoxical breathing has been paid more and more attention by the majority of clinicians. Since the 1950s, the treatment of paradoxical breathing in thoracic trauma has been carried out on the basis of simple compression by external fixation of the chest belt, rib suspension, rib wire fixation, Kirschner pin fixation, and chest wall suspension, resulting in many surgical procedures aimed at fixing the chest wall and achieving certain efficacy. Into the 1980s, due to the popularity of ventilators, more and more application of ventilatory endotracheal fixation. Since most of the patients with either continuous shackle chest or sternal fracture were accompanied by pulmonary contusions, the application of ventilator for endotracheal fixation controlled paradoxical breathing while effectively treating pulmonary contusions and also overcame the inconvenience of care due to external fixation. Endotracheal fixation by ventilator was accepted by most surgeons and soon gained popularity, but the application of ventilator therapy required 2 to 3 weeks for the chest wall to reach stability, and more than 1 week required tracheotomy. Mechanical ventilation brings many complications such as tracheal ulceration, stenosis, ventilator pneumonia, and expensive ICU costs. Transnasal tracheal intubation has also been used instead of tracheotomy, but this measure requires a high level of operative skill. The success rate is very low and the patient tolerates it poorly. In addition, it is difficult to correct severe thoracic deformities and scoliosis with mechanical ventilation alone. In recent years, the advent of absorbable rib nails and claw-shaped titanium rib splints has enabled effective correction and treatment of thoracic deformities. 56 patients with severe thoracic deformities have been treated surgically with absorbable rib nails and claw-shaped titanium rib splints to correct thoracic deformities and control paradoxical breathing since 2006, with an excellent rate of 94.6%. The excellent rate reached 94.6%, and achieved very good efficacy. Especially in primary hospitals, where ICU ward facilities are not perfect enough to effectively control ventilatory disease, surgical orthopedic treatment can reduce ventilator use. Clinical evaluation of its advantages: (1) effective control of paradoxical breathing; (2) correction of thoracic deformity and scoliosis; (3) reduction of ventilator application time; (4) effective management of combined thoracic and abdominal injuries; (5) avoidance of reoperation to remove fixations; suitable for application in primary hospitals. However, its long-term efficacy remains to be observed in a large number of cases.