Treatment of Flail Chest
Definition and Clinical Presentation
- Flail chest is a clinical finding characterized by paradoxical movement of a chest wall segment during respiration, resulting from a contiguous segment of 3 or more consecutive ribs fractured at 2 or more places 1, 3
- Patients typically present with rapid breathing, respiratory distress, paradoxical chest wall movement, and may develop shock, especially when combined with pulmonary contusion 4, 5
Initial Management
- Control paradoxical chest wall movement as soon as possible, maintain airway patency, provide adequate oxygen supply, correct respiratory and circulatory dysfunction to prevent shock, and consider chest fixation with a multi-head chest strap for immediate stabilization 4, 5
Definitive Treatment Options
1. Surgical Stabilization of Rib Fractures (SSRF)
- The American College of Surgeons recommends SSRF as the primary treatment approach for flail chest patients, as it is associated with better long-term pulmonary function and reduced chest wall deformity 1, 2, 3
- Indications for SSRF in flail chest include all flail chest patients, especially those with anterolateral flail segments with displacement, respiratory failure without severe pulmonary contusion, and patients with pulmonary contusion and persistent chest wall instability or weaning failure 1, 2, 3
- Benefits of SSRF include better long-term pulmonary function, reduced chest wall deformity, and more cost-effective despite the added surgical expense 1, 3
- SSRF is optimal in dedicated centers with a multidisciplinary team that has developed protocols for both operative and non-operative management 1, 2, 3