Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Updated: Aug 28 2023

Flail Chest


  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon


Images chest 1a.jpg chest 1b.jpg
  • summary
    • Flail Chest is a traumatic chest injury defined as segmental fractures of 3 or more ribs and is often associated with pulmonary injuries such as hemothorax and pneumothorax.
    • Diagnosis is made with radiographs of the chest. 
    • Treatment can be nonoperative or operative depending on the presence of respiratory compromise, the number of consecutive rib fractures, and the presence of open fractures. 
  • Epidemiology
    • Bimodal distribution
      • younger patients involved in trauma
      • older patients with osteopenia
  • Etiology
    • Mechanism
      • blunt forces
      • deceleration injuries
    • Associated Injuries
      • scapula fractures
      • clavicle fractures
      • hemo/pneumothorax
  • Prognosis
    • Varies depending on underlying pulmonary injury or other concomitant injuries
  • Anatomy
    • Osteology
      • 12 ribs per side
        • the first seven pairs are connected with the sternum
        • the next three are each articulated with the lower border of the cartilage of the preceding rib
        • the last two have pointed extremities
      • can have an accessory clavicular rib
      • anterior ribs articulate with the sternum via the costal cartilage
    • Blood Supply
      • derived from intercostal vessels
  • Presentation
    • Symptoms
      • pain
      • respiratory difficulty
      • hemopneumothorax
    • Exam
      • paradoxical respiration
        • area of injury "sinks in" with inspiration, and expands with expiration (opposite of normal chest wall mechanics)
      • chest wall deformity can be seen
      • bony or soft-tissue crepitus is often noted
  • Imaging
    • Radiographs
      • may be hard to distinguish non- or minimally-displaced rib fractures
      • may see associated hemothorax
    • CT
      • improved accuracy of diagnosis with CT (vs. radiographs)
  • Treatment
    • Nonoperative
      • observation
        • indications
          • no respiratory compromise
          • no flail chest segment (>3 consecutive segmentally fractured ribs)
        • techniques
          • pain control
            • systemic narcotics or local anesthetics
          • positive pressure ventilation
    • Operative
      • open reduction internal fixation
        • indications
          • displaced rib fractures associated with intractable pain
          • flail chest segment (3 or more consecutive ribs with segmental injuries)
          • rib fractures associated with failure to wean from a ventilator
          • open rib fractures
        • technique
          • approach
            • full thoracotomy approach
            • limited exposure approach
          • open reduction and internal fixation
            • plate and screw constructs
            • intramedullary splinting
        • postop
          • early shoulder and periscapular range of motion
  • Complications
    • Intercostal neuralgia
    • Periscapular muscle weakness
    • Pneumonia
    • Restrictive type pulmonary function
1 of 0
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options