Flail chest refers to
Fracture of Sternum
Fracture of multiple ribs
Open pneumothorax
Tension pneumothorax
(B) Fracture of multiple ribs > A flail chest occurs when a segment of the chest wall does not have bony continuity with the rest of the thoracic cage .> Flail chest usually results from blunt trauma associated with multiple rib fractures i.e. 3 or more ribs fractured in 2 or more places.# Major chest wall trauma (Flail chest)> This occurs when several adjacent ribs are fractured in two places either on one side of the chest or either side of the sternum.> The flail segment moves paradoxically, i.e.-inwards during inspiration and outwards during expiration, thereby reducing effective gas exchange.> The net result is poor oxygenation from injury to the underlying lung parenchyma and paradoxical movement of the flail segment.> The underlying lung injury with loss of alveolar function may result in deoxygenated blood passing into the systemic circulation> This creates a right-to-left shunt and prevents full saturation of arterial blood.> In the absence of any other injuries and, if the segment is small and not embarrassing respiration, the patient may be nursed on a high-dependency unit, with regular blood gas analysis and good analgesia until the flail segment stabilizes.> In the more severe case, endotracheal intubation is required with positive-pressure ventilation for up to 3 weeks, until the fractures become less mobile.> Thoracotomy with fracture fixation is occasionally appropriate if there is an underlying lung injury to be treated at the same time.> An anterior flail segment with the sternum moving paradoxically with respiration can be stabilized by internal fixation but operative management is not usually for either.
Miscellaneous