Flail chest

Flail Chest

Flail chest is a serious thoracic injury characterized by the fracture of three or more adjacent ribs in two or more places, leading to a segment of the chest wall that is not attached to the rest of the thoracic cage. This condition is often the result of blunt trauma and can significantly impair respiratory function due to the paradoxical movement of the affected segment. During inhalation, the injured segment moves inward rather than outward, reducing the efficiency of breathing and potentially leading to life-threatening complications.

Etiology

The most common cause of flail chest is blunt trauma, typically resulting from motor vehicle accidents, falls from significant heights, or direct impacts. Less frequently, it can occur due to violent coughing or resuscitation efforts that lead to rib fractures.

Pathophysiology

In a healthy individual, the chest wall moves outward during inhalation and inward during exhalation. However, in flail chest, the detached segment of the chest wall moves in the opposite direction due to the negative intrathoracic pressure created during inspiration. This paradoxical movement not only decreases the efficiency of ventilation but also can lead to the development of pulmonary contusion, further exacerbating respiratory compromise.

Clinical Presentation

Patients with flail chest typically present with severe chest pain, difficulty breathing, and noticeable deformity of the chest wall. The paradoxical movement of the chest wall may be visible in severe cases. Additional symptoms may include cyanosis, tachypnea, and hypoxia due to inadequate ventilation and oxygenation.

Diagnosis

Diagnosis of flail chest is primarily clinical, supported by the patient's history and physical examination. Imaging studies, particularly chest X-rays and CT scans, are crucial for confirming the diagnosis and assessing the extent of the injury, including the presence of underlying lung injuries.

Management

The management of flail chest aims to ensure adequate ventilation, relieve pain, and prevent complications. Initial treatment includes securing the airway, providing supplemental oxygen, and, in severe cases, mechanical ventilation. Pain management is critical and may involve the use of analgesics and regional anesthesia techniques. Surgical fixation of the rib fractures may be considered in cases where conservative management fails or in patients with severe respiratory compromise.

Complications

Complications of flail chest can include pneumonia, atelectasis, acute respiratory distress syndrome (ARDS), and chronic pain. Early and aggressive management is essential to minimize these risks.

Prognosis

The prognosis for patients with flail chest varies depending on the severity of the injury and the presence of associated injuries. With appropriate treatment, many patients recover, though some may experience long-term respiratory issues or chronic pain.

Prevention

Prevention of flail chest involves measures to reduce the risk of blunt chest trauma, such as wearing seat belts, using airbags in vehicles, and adhering to safety guidelines in high-risk occupations and sports.