2. A flail chest occurs when a segment of
the rib cage breaks under extreme stress
and becomes detached from the rest of
the chest wall.
This is usually defined as at least two
fractures per rib (producing a free
segment), in at least two ribs.
some definitions require three or more
ribs in two or more places
Flail ChestFlail Chest
3. Most Common – Vehicle Accidents (76%)
Second most common – Falls, especially
in elderly population (weak, frail bones)
(14%)
Third most common – blunt trauma in
children, especially those with genetic
conditions, eg. Osteogenesis Imperfecta.
Flail Chest - causesFlail Chest - causes
4. During normal
inspiration, the
diaphragm contracts
and intercostal
muscles pull the rib
cage out. Pressure in
the thorax decreases
below atmospheric
pressure, and air
rushes in through the
trachea.
Flail Chest – What is happening..?Flail Chest – What is happening..?
5. The flail segment will
be pulled in with the
decrease in pressure
while the rest of the
rib cage expands.
Flail Chest – What is happening..?Flail Chest – What is happening..?
6. During normal
expiration, the
diaphragm and
intercostal muscles
relax increasing
internal pressure,
allowing the
abdominal organs to
push air upwards and
out of the thorax.
Flail Chest – What is happening..?Flail Chest – What is happening..?
7. However, a flail
segment will also be
pushed out while the
rest of the rib cage
contracts.
Flail Chest – What is happening..?Flail Chest – What is happening..?
9. Since the flail segment moves in an opposite
direction to rest of the chest wall
Flail Chest – What is happening..?Flail Chest – What is happening..?
Paradoxical BreathingParadoxical Breathing
10. Pai
n
Flail Chest – ImplicationsFlail Chest – Implications
Pneumothorax,
Hemothorax
Mediastinal
Flutter
Pulmonar
y
Contusion
Respirator
y
Failure
11. Flail Chest – DiagnosisFlail Chest – Diagnosis
Clinical examination for bruises, paradoxical
movement of flail segment.
Chest X – Ray
Computed
Tomography
13. Flail Chest – ManagementFlail Chest – Management
Analgesia.
Mainstay
Opioid Analgesics (risk of respiratory depression)
NSAIDs
Thoracic or high lumbar Epidurals with or
without Opioid additives.
Posterior rib blocks (lasts upto 24 hours)
Instillation of L.A. into pleural space through
ICD (controversial)
14. Flail Chest – ManagementFlail Chest – Management
Intubation & Ventilation.
Rarely indicated
Indicated for hypoxia due to pulm.
contusions.
Double lumen tracheal tube.
each lumen connected to a different
ventilator.
each lung may require drastically different
pressures and flows to adequately ventilate.
18. Flail Chest – ManagementFlail Chest – Management
Rehabilitation
12 week outpatient program for at least 3
days a week
patient should be seen for 30–45 minutes a
day after a 5-10 minute warm up session.
After discharge, patient should be given an
exercise regimen to be performed at home.
19. Flail Chest – OutcomeFlail Chest – Outcome
Mortality Rate of flail chest ranges from 10-
25%.
Ventilation has little effect on outcome