Flail chest occurs when contiguous ribs each show multiple fractures. It usually occurs after severe blunt force has been applied to the chest and often indicates significant underlying pulmonary contusion.
A flail segment requires:
(1) 2 or more contiguous ribs
(2) each with 2 or more points of fracture
Clinical appearance: Paradoxical motion of the affected chest wall segment during respiration.
Types based on location:
(1) sternal: separation of the sternum from the surrounding ribs
(2) anterior segment
(3) lateral segment
(4) posterior segment: This is rarely clinically apparent because of the muscular support over the back.
where:
• Fractures of the first 2 ribs
• I am not sure if fractures to the 11th or 12th ribs would contribute to a flail chest. I have included the 11th ribs in the implementation, but this is subjective.
• While it usually takes significant blunt trauma to cause a flail chest, patients with underlying bone disease may develop flail chest after relatively minor injuries.
Other injuries to look for in a patient with flail chest:
(1) pneumothorax
(2) hemothorax
(3) intra-abdominal injuries
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