Flail chest

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Background

  • Due to segmental fractures (in 2 or more locations on same rib) of 3 or more adjacent ribs
    • Leads to free-floating segment of ribs that no longer attach to rest of thorax
  • Commonly associated with respiratory failure (due to pulmonary contusion)

Evaluation

  • Paradoxical movement of affected segment (inward movement of involved portion during inspiration, outward during expiration)

Differential Diagnosis

Thoracic Trauma

Management

  • Otherwise healthy patients with mild-moderate flail chest may be managed without positive pressure ventilation
  • Analgesia
  • Consider intubation even if patient's breathing initially seems adequate, especially if:
    • Shock
    • Severe head injury
    • Comorbid pulmonary disease
    • Fracture of 8 or more ribs
    • Age >65
  • Surgical fixation is controversial

See Also