Flail chest

Defination:
Flail chest may be define as fracture of three or more
successive ribs at two or more different sites resulting in a segment
of chest wall which moves paradoxically with respiration
When the rib fractures one or either side of the sternum and
the whole sternal segment is indriven it is called stove-in-chest

Cause: crushing blow to chest. In Associated condition:

 RTA  Haemothorax
 Building collapse,  Pneumothorax
earthquake  Damage to the
 Extreme external cardiac lung
message
Pathology
1. Paradoxal movement – the entire flail segment moves inward
during inspiration and outwards during expiration
2. Reduces effective gas exchange
3. Poor oxygenation [ due to underlying pulmonary contusion
(lung parenchyma)]
4. Hypoxia
5. compromised ventilation
6. respiratory failure

Diagnosis
1. H/O – Crushing or blowing chest injury
2. C/F –
a. Severe chest pain
b. Dyspnoea
c. Restlessness

3. O/E
a. Look
i. Respiratory distress
ii. Paradoxical movement of flail segment
iii. Deformity of chest wall
iv. cyanosis
b. Feel
i. Severe tenderness
c. Auscultation
i. Breath sound diminished – on affected side
ii. Vocal resonance – increased
[It is a clinical condition so diagnosis clinically, immediate resuscitation
then go for investigation]
Investigation
1. X – ray chest A/P view – multiple rib fracture
2. Blood gas analysis – decrease PO2
Treatment
1. Resuscitation –
a. Oxygen inhalation
b. Adequate fluid infusion carefully [ chance of fluid
overload]
c. Analgesics
2. If patient remain hypoxic
a. Endotracheal intubation
b. Positive pressure ventilation for 3 weeks
3. Mild to moderate case –
i. Not associated with other injury
ii. Flail segment is small
iii. Not embarrassing respiration

a. Treated in HDU
b. Regular blood gas analysis
c. Good analgesic
4. Severe case [ Associated with
underlying lung injury]
a. Thoracotomy
b. Internal fixation of rib by K-wire [ Rarely - in costo-
chondral disruption]

N.B – in quit respiration paradoxical movement may not be

apparent. If patient cough or take deep breath it become obvious

It is a life threatening medical condition that occurs when a segment of rib cage
breaks under extreme stress and detached from the rest of the chest wall
Defined as at least two fractures per rib (producing free segment) in at least two
ribs
A segment of the thoracic cage is separated from the rest of the chest wall
The segment is flail and unable to contribute lung expansion
Fracture of at least three consecutive ribs, each in
two locations, causing free-fl oating segment of chest wall .