Flail chest

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD's medical weight loss NYC, sleep center NYC
Philadelphia medical weight loss and Philadelphia sleep clinics

Flail chest
Illustration of flail chest
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Chest pain, difficulty breathing, paradoxical breathing
Complications	Pneumothorax, pulmonary contusion, respiratory failure
Onset	Trauma
Duration	Varies
Types	N/A
Causes	Blunt trauma to the chest
Risks	Motor vehicle collision, falls, assault
Diagnosis	Physical examination, chest X-ray, CT scan
Differential diagnosis	Rib fracture, pneumonia, pleural effusion
Prevention	N/A
Treatment	Oxygen therapy, pain management, mechanical ventilation
Medication	N/A
Prognosis	Depends on severity and associated injuries
Frequency	Common in severe chest trauma
Deaths	N/A

Flail chest is a serious medical condition that occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall. This condition is often associated with severe blunt trauma to the chest and can lead to significant respiratory distress.

Pathophysiology

Mechanics of flail chest

Flail chest occurs when multiple adjacent ribs are fractured in multiple places, creating a segment of the chest wall that is not attached to the rest of the rib cage. This segment moves independently from the rest of the chest wall, often in a paradoxical motion during breathing. During inspiration, the flail segment moves inward while the rest of the chest expands, and during expiration, it moves outward while the rest of the chest contracts. This paradoxical movement impairs effective ventilation and can lead to inadequate oxygenation of the blood.

Clinical Presentation

Patients with flail chest typically present with severe chest pain, difficulty breathing, and visible deformity of the chest wall. The paradoxical movement of the flail segment can often be observed during physical examination. Patients may also exhibit signs of respiratory distress, such as tachypnea, cyanosis, and hypoxemia.

Complications

Pulmonary contusion associated with flail chest

Flail chest is often associated with other injuries, such as pulmonary contusion, which is a bruise of the lung tissue that can further compromise respiratory function. Other potential complications include pneumothorax, hemothorax, and respiratory failure. The presence of these complications can significantly worsen the prognosis and increase the risk of mortality.

Diagnosis

The diagnosis of flail chest is primarily clinical, based on the observation of paradoxical chest wall movement and the presence of multiple rib fractures. Imaging studies, such as chest X-rays or CT scans, can confirm the diagnosis and assess the extent of the rib fractures and any associated injuries.

Management

X-ray showing flail chest

The management of flail chest focuses on stabilizing the chest wall, ensuring adequate ventilation, and treating any associated injuries. Pain control is crucial and can be achieved with analgesics or regional anesthesia techniques such as epidural analgesia. Mechanical ventilation may be required in severe cases to support breathing and improve oxygenation. Surgical intervention may be necessary to stabilize the flail segment, especially in cases where conservative management is insufficient. Techniques such as rib fixation with plates or wires can help restore the integrity of the chest wall and improve respiratory mechanics.

Prognosis

The prognosis of flail chest depends on the severity of the injury, the presence of associated injuries, and the effectiveness of the management. Early recognition and appropriate treatment are essential to improve outcomes and reduce the risk of complications.

See also

• Rib fracture
• Pulmonary contusion
• Pneumothorax
• Hemothorax

CT scan of flail chest