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Flail Chest

Flail Chest is a topic covered in the 5-Minute Emergency Consult.

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  • 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.


  • 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° 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

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Rosen, Peter, et al., editors. "Flail Chest." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307549/all/Flail_Chest.
Flail Chest. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307549/all/Flail_Chest. Accessed April 23, 2019.
Flail Chest. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307549/all/Flail_Chest
Flail Chest [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. 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 - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, 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 - 5 DB - Emergency Central DP - Unbound Medicine ER -