The four columns of the thorax - operative decision making in the setting of complete bony instability.

Abstract Thoracic skeletal injury is a common outcome of motor vehicle accidents. Skeletal reconstruction is guided by anatomic and physiologic variables dictated by the injury complex. Herein, we describe a report of a patient who sustained complex trauma to the thorax leading to complete thoracic dissociation. Clinical and operative decision making is discussed to inform the reader of a proposed ordered protocol and considerations for operative intervention and reconstruction.