A flail chest occurs as a result of a trauma to the chest, leading to at least 3 ribs becoming fractured or broken, close together, with pieces of bone detaching from the chest wall. These segments of bone start to move independently of the chest wall and in the opposite direction because of lung pressure. The damaged rib cage prevents the lungs expanding fully, in this area.
Ribs surround and support the chest, protecting the organs in the thoracic cavity, the heart and the lungs. It forms part of the respiratory system, allowing inhalation and exhalation. The human body has 12 pairs of ribs (24). The space in between the ribs is known as the intercostal space.
The first seven pairs are true and attach to the costal cartilage and the sternum. Ribs 8, 9 and 10 are referred to as false ribs, and they attach to the costal cartilage of the sternum and the last 2 are floating ribs.
A flail chest is a life threatening condition and medical treatment must be sought immediately if damage to the rib cage is suspected. If fragments of bone are left floating around the chest cavity they could potentially damage the heart and lung tissue.
Flail chest is a common cause of death in the young and the old.
- Fall (for example, off a bicycle or a horse)
- Blunt trauma to the chest (for example, during a tackle in rugby), cricket.
- Very rarely it is caused by bone disease in the elderly.
- Injury usually caused by a severe blow unless patient has osteoporosis (weakening of the bones) and in this situation maybe caused by a lesser blow.
- Inflammation and bruising
- Uneven chest rise when breathing, one part of the chest might move independently of the other.
- In a car accident, evidence of a seat belt mark.
It is vital that medical treatment is sought immediately to prevent the condition becoming life threatening. A chest x ray will help identify a flail chest. Further evidence of a flail chest can be identified through bruising to the chest and punctured blood vessels.
As patients with flail chest are susceptible to pneumonia and complications arising from damage to the lungs and heart, medical treatment focuses on trying to prevent these from developing.
- Oxygen (given via an oxygen mask)
- Rest, and ensuring the patient is resting in a comfortable position.
- Pain killers, analgesia, and anti-inflammatories for pain management.
- Ice, to help reduce the inflammation and to assist with pain control.
- Depending on the severity of the flail chest, mechanical ventilation or/and surgery might be required.
Sophia Cross, BA (Hons) MA