Flail Chest
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Basics
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
- 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
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
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
- 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
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