Flail Chest
Basics
Description
Description
- Free-floating segment of chest wall:
- 3 or more adjacent ribs are fractured in 2 or more places
- Rib fractures in conjunction with sternal fractures or costochondral separations
- The free-floating segment of chest wall paradoxically moves inward during inspiration and outward during expiration
- The principal pathology associated with flail chest is the associated pulmonary contusion:
- There is no alteration in ventilatory mechanics owing to the free-floating segment
Etiology
Etiology
- Blunt thoracic trauma
- Fall from a height
- Motor vehicle accident
- Assault
- Missile injury
- Ribs usually break at the point of impact or posterior angle:
- Ribs 4–9 most prone to fracture
- Weakest point of ribs is 60-degree rotation from sternum
- Transfer of kinetic energy to the lung parenchyma adjacent to the injury:
- Disruption of the alveolocapillary membrane and development of pulmonary contusion
- Arteriovenous shunting
- Ventilation/perfusion mismatch
- Hypoxemia
- Respiratory failure may result
Pediatric Considerations
- Relatively elastic chest wall makes rib fractures less common in children
- Presence of rib fractures implies much higher energy absorption
Geriatric Considerations
Much more susceptible to rib fractures:
- Described with low-energy mechanisms
- Complicated by osteoporosis
There's more to see -- the rest of this topic is available only to subscribers.
Citation
Schaider, Jeffrey J., et al., editors. "Flail Chest." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307549/all/Flail_Chest.
Flail Chest. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307549/all/Flail_Chest. Accessed December 10, 2024.
Flail Chest. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307549/all/Flail_Chest
Flail Chest [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 10]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307549/all/Flail_Chest.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Flail Chest
ID - 307549
ED - Barkin,Adam Z,
ED - Shayne,Philip,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307549/all/Flail_Chest
PB - Lippincott Williams & Wilkins
ET - 6
DB - Emergency Central
DP - Unbound Medicine
ER -