What is flail chest?
Flail chest is a serious chest injury where a segment of the rib cage breaks in multiple places and becomes detached from the rest of the chest wall. This causes part of the chest to move in the opposite direction of normal breathing—inward during inhalation and outward during exhalation—a condition called paradoxical movement. It often occurs after significant trauma, such as a car accident or fall.
What causes flail chest?
The main cause is blunt trauma to the chest that fractures three or more adjacent ribs in two or more places. This can happen due to:
- Motor vehicle accidents
- Falls from height
- Crushing injuries
- Direct blows to the chest, such as during contact sports or physical assault
Severe trauma like this not only affects the ribs but may also damage underlying organs like the lungs, making it a life-threatening emergency.
What are the symptoms of flail chest?
Symptoms include:
- Severe chest pain, especially when breathing or coughing
- Difficulty breathing or shortness of breath
- Visible paradoxical movement of the chest wall
- Bruising or swelling over the rib cage
- Crepitus (a crackling sound or feeling under the skin due to broken bones or trapped air)
- Fatigue or cyanosis (bluish skin from lack of oxygen) in severe cases
Symptoms may worsen rapidly, especially if there is lung involvement such as a pneumothorax (collapsed lung).
Why is flail chest dangerous?
Flail chest is dangerous because it interferes with normal breathing mechanics and may cause:
- Respiratory failure
- Lung contusions (bruising) or collapse
- Decreased oxygen levels
- Shock from severe trauma
- Increased risk of pneumonia
It often occurs alongside other critical injuries, making early treatment essential.
How is flail chest diagnosed?
Diagnosis involves:
- Physical examination, noting paradoxical chest movement
- Chest X-ray, to identify rib fractures and lung damage
- CT scan, which provides a more detailed view
- Pulse oximetry or arterial blood gases, to assess oxygen levels
- Monitoring for signs of respiratory distress
Early recognition and supportive care are crucial for preventing complications.
What is the treatment for flail chest?
Treatment focuses on stabilizing the chest wall, managing pain, and supporting breathing.
Initial treatment may include:
- Oxygen therapy, to improve breathing
- Pain management, often with nerve blocks or epidural anesthesia
- Monitoring in an ICU, especially if breathing is compromised
Additional treatments:
- Mechanical ventilation, in severe cases where the patient can’t breathe adequately on their own
- Chest tube placement, if there’s a pneumothorax or hemothorax
- Surgical fixation of the ribs, in some cases, to stabilize the chest wall and improve recovery
Supportive care like pulmonary hygiene, coughing exercises, and physical therapy may also be needed to prevent pneumonia.
What is the outlook for someone with flail chest?
The prognosis depends on:
- Severity of the chest injury
- Presence of other injuries, like head trauma or internal bleeding
- Age and overall health of the patient
- Promptness of treatment
With proper medical care, many patients recover well, though elderly individuals or those with underlying lung disease may have longer recovery times or complications.
How long does it take to recover?
- Hospital stay: Typically several days to weeks
- Full recovery: May take 6–8 weeks or more, depending on severity
- Patients may need physical therapy and breathing exercises as part of rehabilitation
When should someone seek emergency help?
Call emergency services if someone experiences:
- Severe chest pain after trauma
- Difficulty breathing
- Bluish lips or face
- Rapid or shallow breathing
- Unusual chest movement after injury
These may be signs of a flail chest or other life-threatening chest injuries.