Flail Chest: Symptoms, Causes, Treatment

What are the symptoms of flail chest?

Flail chest is a serious condition that occurs when a segment of the rib cage breaks due to trauma, resulting in a section of the chest wall moving independently from the rest of the chest. This can lead to a number of symptoms, including:

1. Chest pain: Severe pain at the site of the injury, which may worsen with breathing or movement.
2. Difficulty breathing: Shallow or rapid breathing, as the flail segment can interfere with the normal expansion and contraction of the lungs.
3. Shortness of breath: Feeling like you can’t get enough air, which can be a sign of reduced lung function due to the flail chest.
4. Chest wall movement: Paradoxical movement of the flail segment, meaning it moves inward when you inhale and outward when you exhale, opposite to the normal movement of the chest wall.
5. Tenderness or bruising: Tenderness, swelling, or bruising over the injured area of the chest.
6. Crepitus: A grating sensation or sound that occurs when the broken ribs rub against each other or other structures.
7. Coughing: Persistent coughing, which can be caused by irritation of the airways or lungs due to the flail chest.
8. Fatigue: Feeling tired or weak, which can be a result of the increased effort required to breathe with a flail chest.

If you or someone you know experiences these symptoms after a chest injury, it’s important to seek medical attention immediately, as flail chest can lead to serious complications, including respiratory failure.

What are the causes of flail chest?

Flail chest is most commonly caused by blunt trauma to the chest, such as that sustained in a motor vehicle accident, fall, or physical assault. The force of the impact can cause multiple ribs to break in two or more places, creating a segment of the chest wall that moves independently from the rest of the chest.

Other causes of flail chest can include:

1. Crush injuries: Injuries that result in the chest being crushed, such as being trapped between two objects, can cause multiple rib fractures and flail chest.
2. Falls: Falls from a significant height or onto a hard surface can cause enough force to break multiple ribs and lead to flail chest.
3. Physical assault: Blows to the chest from physical assault can cause enough force to break ribs and result in flail chest.
4. Sports injuries: High-impact sports or activities that involve contact or risk of falling, such as football or skiing, can result in enough force to cause flail chest.
5. Osteoporosis: In people with weakened bones due to conditions such as osteoporosis, even a minor trauma or fall may be enough to cause multiple rib fractures and flail chest.
6. Child abuse: In infants and young children, flail chest may be caused by physical abuse resulting in multiple rib fractures.

Flail chest is considered a serious medical emergency and requires immediate medical attention. If you suspect you or someone else has flail chest, seek medical help immediately.

How is the diagnosis of flail chest made?

The diagnosis of flail chest is typically based on a combination of clinical evaluation, physical examination, and imaging studies. The following steps are usually involved in diagnosing flail chest:

1. History and physical examination: Your healthcare provider will take a detailed history, including the mechanism of injury and any symptoms you are experiencing. They will then perform a physical examination, which may include inspecting the chest for signs of injury, such as bruising, swelling, or deformity, and listening to your breathing.
2. Chest X-ray: A chest X-ray is often the first imaging study performed to assess for rib fractures and the presence of a flail segment. A flail chest is typically diagnosed if three or more consecutive ribs are fractured in two or more places.
3. CT scan: A CT scan may be performed to provide more detailed images of the chest wall and to assess for any associated injuries, such as lung contusions or other chest injuries.
4. Pulmonary function tests: Pulmonary function tests may be performed to assess the impact of the flail chest on lung function and breathing.
5. Arterial blood gas analysis: An arterial blood gas analysis may be done to assess oxygen and carbon dioxide levels in the blood and to evaluate the severity of respiratory compromise.
6. Ultrasound: In some cases, ultrasound may be used to assess for the presence of a pneumothorax (collapsed lung), which can be a complication of flail chest.

Once a diagnosis of flail chest is confirmed, treatment will be initiated based on the severity of the injury and associated symptoms.

What is the treatment for flail chest?

The treatment for flail chest aims to stabilize the chest wall, relieve pain, support breathing, and prevent complications. Treatment options may include:

1. Pain management: Pain from flail chest can be severe and may interfere with breathing. Pain medications, such as opioids or nonsteroidal anti-inflammatory drugs (NSAIDs), may be prescribed to help manage pain.
2. Respiratory support: Flail chest can impair lung function and breathing. In severe cases, mechanical ventilation may be necessary to support breathing and ensure adequate oxygenation.
3. Chest wall stabilization: Stabilizing the chest wall can help reduce movement of the flail segment and improve breathing. This may be done using a chest brace or other devices to hold the chest wall in place.
4. Physical therapy: Physical therapy may be recommended to help improve lung function, strengthen respiratory muscles, and promote recovery.
5. Monitoring and observation: Close monitoring of vital signs, oxygen levels, and chest X-rays may be necessary to monitor for complications and assess progress.
6. Treatment of associated injuries: If the flail chest is associated with other injuries, such as lung contusions or pneumothorax, these may need to be treated as well.
7. Surgical intervention: In some cases, surgery may be necessary to stabilize the chest wall, repair fractures, or remove any trapped air or fluid from the chest cavity.

The specific treatment approach will depend on the severity of the flail chest, the presence of associated injuries, and the individual patient’s condition. It’s important to seek prompt medical attention if you suspect you have a flail chest, as this is a serious condition that requires immediate treatment.