Unstable thoracic cage injuries were classified as sternal, anterior, lateral and posterior flail chest. Dennis mccool, in goldmans cecil medicine twenty fourth edition, 2012. This is accompanied by paradoxical motion of the affected chest wall segment during respiration such that the flail segment collapses during inspiration and expands during expiration. Usually there are at least two breaks per rib and in more than one rib to produce a flail chest.
Management of flail chest is directed toward pain relief, ventilatory support, and monitoring for deterioration. A flail chest is defined as a section of the thoracic cage that is separated from the chest wall. Flail chest is a traumatic condition of the thorax. In 56 patients surgical stabilization was performed with metal plates as described. Pneumothorax nursing, pathophysiology, interventions open vs closed vs. The mean iss was 75 for patients with cranial trauma and flail chest and 55. A chest xray is less sensitive than ct for the diagnosis of flail segments 4. A flail chest is created when three or more ribs are fractured at two or more places each, creating a freely moving segment of chest wall that moves paradoxically to the rest of the chest. The paramedics arrived and transported the patient to a rural community. Titanium plate fixation of flail chest sciencedirect.
Flail chest, a fracture of the ribs causing them the separate from the rest of the chest wall, is an injury usually caused by blunt force trauma to the chest wall. Mechanism of injury, injury patterns and associated injuries in. Clinically, a segment of only one or two ribs can act as a flail segment, hence there is some controversy between the clinical and radiological definitions. Oct 03, 2017 flail chest is an extremely severe injury, and its imperative that youre treated immediately. It is considered a clinical diagnosis as everybody with this fracture pattern does not develop a flail chest. They reported that continued mechanical ventilation is required for internal stabilization of chest wall. Atls manual suggest no change in the manage ment of ventilation in this. Persistent pain, severe chest wall instability, and a progressive decline in pulmonary function testing in a patient with flail chest are also indications for surgical stabilization. Flail chest is defined as the fracture of four or more consecutive ribs in at least two places. A flail chest is defined as double fractures of 3 or more adjacent ribs.
Flail chest is a consequence of an application of large forces to the chest, leading to severe trauma and is included to the major, often lifethreatening, decelerational injuries along with aortic disruption, tracheobronchial disruption and sternal fracture serving as markers of significant intrathoracic injury 3,9. Flail chest occurs following trauma in which there have been either double fractures of three or more contiguous ribs or combined sternal and rib fractures. Pulse oximetry, if available, is also useful to detect hypoxia. Flail chest is a serious type of injury to the chest, that results when three more more ribs are broken, for example, as the result of a road traffic accident. Flail chest health encyclopedia university of rochester. While other types of rib fractures are painful and can somewhat affect breathing, they are not a flail chest because the overall function of the rib cage will be normal. Its management is often complicated by the other injuries it is frequently associated with. Some evidence now suggests rib fixation can improve patient outcomes. The pathophysiology of flail chest injury thoracic key. Gently feel the injured site and locate the edges of the flail chest. Sepsis and subarachnoid bleeding were the major causes of mortality. The respiratory rate may be the most important parameter to follow.
Rib fractures control pain analgesics opiates nsaids local rib blocks thoracic epidural admit it patient elderly, 3 rib fractures. A 62yearold man with aortic dissection and flail chest. Flail chest the breaking of 2 or more ribs in 2 or more places, resulting in free floating rib segments. Methods the national trauma data bank was used for a retrospective analysis of the injury patterns, management, and clinical outcomes associated with flail chest injuries. The first modern approach for flail chest was established by avery et al. Aug 11, 2016 severe blunt injury to the chest continues to be one of the leading causes of morbidity and mortality in both young and old trauma victims. Flail chest saint francis veterinary center of south jersey. A flail chest is the result of double fractures of at least three or more adjacent ribs, which causes the thoracic cage to become unstableto flail see figure 211. The fractured segment of ribs moves paradoxically, meaning that it. Surgical stabilization of severe flail chest ctsnet. Baisden, md flail chest is most often accompanied by a signi.
Flail chest, along with chest wall deformity, the most severe of chest wall injuries, is. Twenty three were treated with internal pneumatic stabilization alone because of associated cerebral injuries or massive pulmonary contusions. The result is an unstable segment of the chest wall, which moves paradoxically inward with inspiration and outward with expiration. Ems is dispatched to a 2car mvc with head on collision. This affected portion is unable to contribute to expansion of the lungs, which creates some obvious problems for the patient hampered breathing and. A flail chest describes when a segment of the rib cage breaks due to blunt thoracic trauma, high. Flail chest is a lifethreatening 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. Flail chest and pulmonary contusion renata bastos, md, john h. Rib fractures are notoriously painful and can lead to prolonged hospitalization, contribute to the development of pneumonia and respiratory failure, and delay outpatient recuperation significantly. Oct 11, 2011 flail chest everything you need to know dr. Patients with a flail chest injury admitted from 2007 to 2009 were included in the analysis. Severe flail chest requiring internal pneumatic stabilization andor surgical stabilization was present in 79 patients. Patient 1 is a 12 year old male atv driver with left thorax handlebar impalement with a flail segment of ribs 48.
Pathophysiology and management of the flail chest request pdf. Flail chest describes a situation in which a portion of the rib cage is separated from the rest of the chest wall, usually due to a severe blunt trauma, such as a serious fall or a car accident. Flail chest definition of flail chest by the free dictionary. The affected ribs cave in flail during inspiration as a result of the subatmospheric intrapleural pressure. Jun 06, 20 bruises or discoloration in the chest area. Two of the symptoms of flail chest are chest pain and shortness of breath it occurs when multiple adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall moves independently. Full text get a printable copy pdf file of the complete article 843k, or click on a page image below to browse page by page. A flail chest arises when these injuries cause a segment of the chest wall to move independently of the rest of the chest wall. Two of the symptoms of flail chest are chest pain and shortness of breath. Management of traumatic flail chest in intensive care unit.
The mortality associated with flail chest is up to 40%. The goal of emergency care is to stabilize the affected section of the ribs. Pdf understanding of flail chest injuries and concepts. Aug 11, 2016 flail chest is an indicator of significant kinetic force to the chest wall and rib cage, but it may also may occur with lesser trauma in persons with underlying pathology, including osteoporosis, total sternectomy, and multiple myeloma, as well as individuals with congenital absence of the sternum. Flail chest is a lifethreatening injury typically treated with supportive ventilation and analgesia. The purpose of this brief is to summarize the clinical and economic value of operative fixation for treatment of flail chest based on current evidence. There are two main approaches to treating flail chest, surgical fixation and conservative management including mechanical ventilation.
Clinically, a flail chest manifests as paradoxical incursion rather than excursion of the floating segment of chest wall during inspiration videos 761 and 762. Your doctors will need to protect your lungs while ensuring that you can breathe adequately. Flail chest, surgical rib fixation, mechanical ventilation, pulmonary function, multiple rib fracture. There is usually no sucking chest wound and there can be various lung sounds heard that are nonspecific for flail chest. Pdf flail chest is one of the lethal six injuries that can be sustained following blunt chest trauma. It may occur when 3 or more ribs are broken in at least 2 places. In a flail chest, the affected side goes down with inspiration and up with expiration. Flail chest is defined as the presence of three or more consecutive ribs with fractures in two or more places creating a floating segment in the chest wall flail chest is usually a consequence chest wall injuries after blunt trauma in children. A 62yearold man with aortic dissection and flail chest air. This is usually defined as at least two fractures per rib producing a free segment, in at least two ribs.
In simple terms, it can be defined as a fracture of three or more ribs at two or more places. He believed the driver of the truck did not see him and drove over him. The patient was a 40yearold male snowmobile driver who was hit by a train. Flail chest basic information description and cause flail chest arises with trauma and occurs when several contiguous ribs are broken in such a way that a segment of the chest wall moves in and out independent of the movement of the remaining normal rib cage. Sep 23, 2016 anatomically, a flail segment is a part of the chest wall which has lost its continuity with the chest wall and usually results from multiple rib fractures. The paramedics arrived and transported the patient to a rural commu nity hospital. Flail chest is an extremely severe injury, and its imperative that youre treated immediately.
Flail chest definition of flail chest by medical dictionary. However, do not attempt to strap, bind or tape the injured section of the chest wall. Management of patients with flail chest by surgical fixation. The novel use of nuss bars for reconstruction of a massive flail chest. Flail chest or flail thoracic segment occurs when three or more contiguous ribs are fractured in two or more places.
Rib fractures, flail chest, and pulmonary contusion. Flail chest is one of the worst subset of these injuries and is likely the most common serious injury to the thorax seen by clinicians. Flail chest is the most serious complication that may occur after thoracic trauma and refers to a segment of the chest wall resulting from at least. Nov 15, 1983 these results show that avoidance of tracheostomy and ventilation in selected patients with flail chest is consistent with a low morbidity and mortality. Outcomes included the number of days on mechanical ventilation, days in the intensive care unit icu, days. Blunt chest trauma accounts for a significant proportion of debilitating and lifethreatening injuries. Request pdf pathophysiology and management of the flail chest flail chest occurs when a series of adjacent ribs are fractured in at least 2 places, anteriorly. Injuries of the lungs or the thoracic wall can create a pleural injury, resulting in the collection of air in the pleural space, which is associated. A case of traumatic flail chest requiring stabilization with surgical.