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Flail chest occurs when a segment of the thoracic cage is separated from the rest of the chest. It is typically defined as having two fractures on a rib, creating a free segment that cannot contribute to lung expansion. This condition can severely impair breathing and may require assisted respiration.
In flail chest, the flail segment moves paradoxically with breathing: it falls inwards when the patient inhales and moves outwards when the patient exhales. This condition is very serious and often indicates additional damage to the chest and lungs.
One common associated condition is a pneumothorax, where the lung cannot inflate due to air leaking into the chest cavity. About one-third of cases with three or more fractured ribs also involve a pneumothorax.
Flail chest commonly results from impact injuries, such as those sustained in car accidents involving seat belts. Visible signs include bruising and grazes, and the chest may not rise and fall normally, particularly when the patient is lying flat.
Signs and symptoms of flail chest include:
The primary goal is to stabilise the patient and ensure adequate gas exchange. If possible, sit the patient up, as this position helps with breathing. They may instinctively hold their chest to reduce pain. Note that sitting up may not be possible if the patient has a spinal injury or is in hypovolaemic shock.
Flail chest is especially serious in patients over 65 years old, in cases where fractures occur on both sides of the chest, or when three or more ribs are fractured. Administering oxygen, if available, can help maintain oxygen saturation levels.
A patient with flail chest requires immediate medical attention. Prompt treatment is essential to prevent complications and ensure the best possible outcome.
