FlailChest

Flail chest is a serious chest wall injury characterized by unstable segments of the rib cage, typically resulting from blunt blunt trauma. It usually occurs when two or more consecutive ribs are fractured in two or more places, or when the sternum is involved, creating a free-floating chest wall segment.

The defining feature is paradoxical movement of the affected segment. During inspiration the flail segment moves inward rather than outward, and during expiration it moves outward. This abnormal motion can impair ventilation and contribute to hypoxemia, especially when pulmonary contusion or other chest injuries are present.

Causes are most often blunt trauma from motor vehicle accidents, falls, or crush injuries. Associated injuries commonly include pulmonary contusion, pneumothorax, and hemothorax, which can worsen respiratory compromise and complicate management.

Diagnosis is based on clinical examination and imaging. Observing paradoxical chest movement is a key sign. Chest radiographs and computed tomography help delineate rib fractures and detect accompanying injuries. Ultrasound may aid in assessing pleural fluid and contusions.

Management focuses on airway, breathing, and pain control. Supplemental oxygen and adequate analgesia are essential to enable deep breaths. In many cases, nonoperative care with external stabilization and aggressive pulmonary toilet suffices. Severe flail chest with respiratory failure often requires positive-pressure ventilation to stabilize the chest wall. Regional analgesia or epidural blocks can improve ventilation. Surgical fixation of the flail segment is considered in selected patients who fail medical management or have persistent instability. The prognosis depends on the extent of chest wall injury and associated thoracic injuries.