An Overview of Flail Chest

Flail chest is a serious breach of the integrity of the rib cage when at least three ribs are broken in two or more places. Instead of rigidly holding the normal shape of the chest, as the ribcage is meant to do, flail chest results in a segment of the chest wall flailing back and forth in the opposite direction of the rest of the chest wall (what's known as paradoxical movement).

Flail chest can occur due to a very serious accident, such as a motor vehicle crash. This is a dangerous injury to the ribs that requires emergency medical treatment.

Symptoms

Symptoms of flail chest after a traumatic injury include:

• Paradoxical movement: When someone with this injury inhales and the rest of the chest expands, a flail segment will sink inward. On the other hand, when the rest of the chest contracts on an exhale, the flail segment bulges outward.
• Severe chest pain
• Difficulty breathing

Bruising, inflammation, and sensitivity in the injured area are also expected.

Causes

Flail chest is typically a result of major blunt trauma to the chest wall.

The trauma from a car crash causes 75% of flail chest cases, while falls in the elderly are responsible for 15%. Any blunt trauma can lead to flail chest, such as that from a contact sport.

Rarely, flail chest is due to weak bones or bone disease.

Diagnosis

Flail chest is typically diagnosed during an extensive physical evaluation after a traumatic injury. A computed tomography (CT) scan is the preferred test for identifying flail chest, as an X-ray may not identify all rib fractures.

If a CT scan alone or in combination with an X-ray finds at least three ribs broke in two places, flail chest will be diagnosed.

Medical professionals will monitor for changes in breathing that could be a sign of respiratory failure from flail chest.

What to Do

While this can be a life-threatening condition, there are ways to mitigate the damage if you believe someone has flail chest:

Stay Safe

If you are not the patient, practice universal precautions and wear personal protective equipment, if available. Be sure that whatever caused the injury to the patient is no longer a threat to them—or you.

Call 911

If the 911 operator gives instructions, follow those instructions and ignore the remainder of the steps outlined here. If you cannot call 911, get the patient to emergency medical help as soon as possible.

Stabilize the Flail Chest

Use a pillow to put pressure on the flail segment. Holding the flail segment in place keeps it from moving in the opposite direction of the surrounding muscle and bone. Stabilizing the area will reduce the chances of damage to the heart, lungs, and surrounding tissues.

If a pillow is not available, almost anything soft will do. Roll up a jacket or a blanket. If there is absolutely nothing available, have the patient lie on the affected side of the chest to discourage it from moving.

Brace for the Pain

Regardless of how a flail chest is treated, it is going to hurt—probably worse than anything you or the injured individual has ever encountered. Over-the-counter pain medications aren't going to do much for this level of pain, and stronger painkillers aren't a good idea until emergency medical help is available to provide the full range of emergency treatment.

Try to remain as calm as possible and provide assurance that help is on the way.

Treatment

Emergency medical treatment will first involve the delivery of oxygen, usually through a facemask. Intubation and mechanical ventilation will likely be used for those presenting with lung damage related to flail chest, as well as those who doctors worry will experience a chest cavity collapse.

Surgery may be required, but the decision for this will be based on an individual's case and how stable they are.

Pain control is essential, which may involve an epidural and opioids, though the latter must be carefully prescribed due to the risk of inducing further respiratory concerns in some people.

A Word From Verywell

Though a serious injury, flail chest is usually something most people recover from in several weeks, so long as they are treated promptly. It's important to know, however, that severe cases can lead to stove-in chest—when a part of the chest wall completely collapses. This condition is, in virtually all cases, not something that someone can recover from.