Flail chest is characterized by at least three ribs being broken in more than one place. This causes a part of the bone to become detached from the chest wall.
While it is an uncommon consequence of chest trauma, flail chest can disrupt breathing and cause significant problems for a person.
This article will give an overview of flail chest, its symptoms, treatment, and outlook.
Flail chest overview
The chest wall is a framework of bone and tissue that forms a protective cage around vital organs, such as the heart and lungs. Rib bones are a part of the chest wall.
Ribs are important in protecting vital organs and maintaining open space in the chest. This open space allows the lungs to expand and deflate, during breathing.
Trauma to the chest wall can often occur in road accidents and result in anything from minor bruising to rib fractures. These injuries are most often blunt traumas, so called because they are the result of a blunt or flat object, such as a steering wheel, striking the chest wall but not penetrating the skin.
A rib fracture caused by blunt trauma can produce pain, as the muscles used for breathing continue to pull on the injured area. A blunt trauma that fractures a rib may also cause further injuries, such as puncturing a lung or damaging surrounding blood vessels.
Flail chest is one of the most severe consequences of blunt trauma to the chest wall. In cases of flail chest, three or more ribs break in multiple places, and segments of bone can detach from the chest wall.
This injury causes the affected area to lose its structure, leaving less space for the lungs to expand fully when a person tries to breathe. As a result, the lungs are less able to take in air, causing serious breathing difficulties.
The blunt trauma that leads to flail chest is often caused by a road accident or a fall. In rare cases, it can be a result of bone deterioration or disease.
The symptoms of flail chest vary, depending on its severity. The most common symptoms include:
- severe chest pain
- tenderness of affected area
- breathing difficulties
- inflammation and bruising
- uneven chest rise when breathing
The uneven chest rise is often the clearest sign of flail chest. Here, the affected area will draw in when the person breathes in, while the rest of the chest expands outward. When the person breathes out, the affected area expands out while the rest of the chest draws in.
Diagnosis and treatment
Flail chest is usually a result of a serious injury, and may cause dangerous complications with the lungs. Treatment should be sought immediately.
A case of flail chest is diagnosed through a physical examination, similarly to any rib fracture. An abnormal movement of the chest wall while breathing is a distinctive sign that the injury may be flail chest.
Next, an X-ray is often used if a flail chest is suspected. While most rib fractures do not show up on an X-ray, significant blunt trauma injuries, such as flail chest, can be seen. In some cases, it may take multiple X-rays to detect the injury.
Flail chest is a serious injury, and treatment must be given immediately. Treatment will aim to protect the lungs and ensure that the individual can breathe sufficiently. An oxygen mask will be applied to assist with breathing, and medication will be given to help relieve the pain.
In severe cases, mechanical ventilation is used to help keep the chest cavity stable. Surgery is needed in some cases, such as where the lungs are punctured.
In the past, the treatment of flail chest involved holding patients in position and using rods and braces to direct the affected area of chest outwards. Thankfully, modern treatment approaches are a lot better and more sophisticated.
Flail chest is a serious condition. Immediate, measured treatment is needed to stop it from becoming life-threatening.
With appropriate treatment, young and healthy people can recover with few complications. But the elderly have a raised risk of complications, such as respiratory failure or pneumonia, if flail chest is not managed properly.
Other factors can also cause complications. For example, using mechanical ventilation for a long time can increase the risk of pneumonia and lead to a worse recovery outcome.
In extreme cases, a stove-in chest can occur. This complex condition is the result of a section of the chest wall collapsing. Even if someone with a stove-in chest receives appropriate treatment immediately, the likelihood of surviving a stove-in chest is slim.
However, in the majority of cases of flail chest, where complications do not occur, people can recover from the condition in a matter of weeks, with the right treatment.