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What Is Flail Chest?

Medically Reviewed by Melinda Ratini, DO, MS on May 27, 2021

Your ribs are twelve pairs of bones that wrap from your spine around to the front of your chest. They create a cage that protects some of your most important organs like your lungs and heart. If your ribs are exposed to intense trauma — a serious fall from a significant height, car accident, or another injury — they can break. 

Flail chest is a particular kind of rib fracture that is defined as three (or more) ribs that are broken in two (or more) places. This means that your ribs have a segment that is not connected to the other bones around them. This part of your chest wall, since it is not connected to surrounding structure, can seriously impair your ability to breathe properly. 

How Does Flail Chest Occur?

Most frequently, rib fractures or broken ribs are a result of blunt force trauma to your chest. Some examples of this kind of chest trauma include:  

  • Car or motorcycle accident
  • Fall from substantial height (over 8-10 feet)
  • Fall from a bike or horse
  • Assault
  • Sports injury (from contact sports like football, rugby, or hockey)

If the trauma to your ribs causes them to break in more than two places, there is a chance that you can develop flail chest. 

Other conditions can make you more susceptible to developing flail chest. If you have certain kinds of bone disease, bone deterioration due to aging, or some kinds of cancer, you might be more vulnerable to broken ribs in general.

What Are the Symptoms of Flail Chest?

The official diagnosis of flail chest will rely on an x-ray to confirm. There are some symptoms that you will notice without this imaging. One of the most notable symptoms of flail chest is called paradoxical movement. When you breathe in and your ribcage expands, the broken segment will be sucked inward. Alternately, when you breathe out and your rib cage deflates, it can bulge outward.

Other symptoms of flail chest can include:

  • Bruising, discoloration, or swelling in the area of the broken bones
  • Marks from being thrown against a seat belt (after a car accident)
  • Sharp, severe chest pain
  • Difficulty inhaling or getting a full breath

What Are Complications of Flail Chest?

If untreated, flail chest can be fatal. There are multiple ways in which it can be very dangerous.

When ribs are broken, the ends are often jagged and rough. When they move during breathing or other movement, these fractured ends can cause damage to the surrounding muscles, blood vessels, or even to your lungs and heart. This can cause internal bleeding, which can be life-threatening.

Flail chest also can make it very difficult for you to breathe. If your lungs aren't able to expand all the way, you may not be able to breathe in enough oxygen. This condition, called hypoxia, can cause irreversible damage to your organs or brain. 

Usually, when you have experienced an accident that is traumatic enough to cause flail chest, your lungs can be bruised as well (a condition called a pulmonary contusion). Other internal organs can have bruising or damage as well, and your doctor will likely assess these injuries too. 

One of the most common complications of flail chest after it is stabilized by a doctor is pneumonia

Your doctor will be careful to monitor your breathing, pain level, and take all necessary measures to prevent infection. All of these steps can help you avoid acquiring post-traumatic pneumonia. 

How Is Flail Chest Treated?

There are a few important elements that your doctor will keep in mind when treating your flail chest. These include:

  • Ensuring that you're breathing well and getting enough oxygen
  • Making sure that you're not bleeding internally, or if you are, stopping it surgically
  • Managing your pain to make breathing easier
  • Stabilizing the part of your chest that isn't connected

There are both surgical and non-surgical ways that your doctor can consider approaching the stabilization of your chest wall. A recent study suggested that surgical intervention is a more reliably successful approach. Patients who had their flail chest stabilized surgically had lower rates of complications like pneumonia, emergency tracheostomies, and less need for mechanical ventilation. 

After your flail chest begins to heal, your doctor will ensure that you follow specific directions for pain management, medication, and physical therapy to prevent pneumonia.

What Is the Outlook for Flail Chest?

Flail chest is a true medical emergency and requires a quick response.

When flail chest is quickly diagnosed and treated by a doctor, the outlook for survival and complete recovery is very good. A doctor can quickly minimize your pain, stabilize the parts of your ribs that are broken, and give you supplemental oxygen to make sure your body has enough. 

WebMD Medical Reference

Sources

SOURCES:

American Association for the Surgery of Trauma: "Rib Fractures."

Current Trauma Reports: "Pneumonia in Trauma Patients."

European Journal of Trauma and Emergency Surgery: "Safety and effectiveness of surgical fixation versus non-surgical methods for the treatment of flail chest in adult populations: a systematic review and meta-analysis."

StatPearls: "Flail Chest."

University of Connecticut Korey Stringer Institute: "Pulmonary Contusion."

University of Rochester Medical Center: "Flail Chest."

Yale Medicine: "Rib Fracture (Broken Rib)."

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