Flail chest

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Background

Diagrams depicting the paradoxical motion observed during respiration with a flail segment.
3D reconstruction from a CT scan showing a flail chest. Arrows mark the rib fractures.
  • Due to segmental rib 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)

Clinical Features

  • Paradoxical movement of affected segment
    • Inward movement of involved portion during inspiration, outward during expiration
  • Often have concomitant pulmonary contusion[1]

Differential Diagnosis

Thoracic Trauma

Evaluation

Chest x-ray off a flail chest associated with right sided pulmonary contusion and subcutaneous emphysema.
  • Possibly a clinical diagnosis
  • Consider CXR or chest CT

Management

  • Analgesia
  • Consider positive pressure ventilation
    • Otherwise healthy patients with mild-moderate flail chest may be managed without positive pressure ventilation
  • 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

Disposition

  • Admit

See Also

External Links

References

  1. Davignon K, Kwo J, Bigatello LM. Pathophysiology and management of the flail chest. Minerva Anestesiol. 2004;70(4):193-199.