Flail Chest

What is flail chest?

Flail chest is a medical emergency. It’s life-threatening. It’s very painful.

Flail chest is a traumatic disorder that happens when three or more ribs located next to each other are fractured in two or more places. This causes your chest wall to become unstable, interfering with breathing.

The fractures cause your ribs and chest wall to malfunction in the ways they move. This movement, called paradoxical, means the injured section of your chest wall moves in an opposite direction when compared with your undamaged chest wall.

Flail chest may also be called chest wall instability or deformity.

Who does flail chest affect?

The risk factors for flail chest are similar to risk factors for major trauma. Flail chest tends to happen to people who:

• Are in motor vehicle accidents.
• Fall, especially if you’re older and have osteoporosis.
• Are children with conditions such as osteogenesis imperfecta and childhood metabolic disease.
• Have been assigned male at birth.

What are the signs and symptoms of flail chest?

You may show the following signs and symptoms of flail chest:

• Your breathing is shallow due to extreme pain.
• Your tissues aren’t getting enough oxygen (hypoxia).
• Your lips or fingers are turning blue.

What causes flail chest?

The primary cause of flail chest is trauma, mainly motor vehicle accidents. The next most common cause is falls in older people who may have osteoporosis.

How is flail chest diagnosed?

Your healthcare provider will diagnose flail chest mainly by observing your breathing. The breaks in your ribs show up when you breathe in and out. The line of your chest will pop out more during exhaling and go in farther during inhaling if you have flail chest.

What tests will be done to diagnose flail chest?

Your healthcare provider may order chest X-rays. These will show bone breaks but not changes in cartilage. Chest X-rays are also likely to show bruises to your lung.

Your provider may also touch (palpate) you and be able to feel that you have broken ribs.

How is flail chest treated?

At first, you’ll get oxygen and be monitored. You’ll be medicated for pain if you have flail chest to make sure the pain doesn’t interfere with your breathing. Your healthcare team will also perform pulmonary hygiene measures to keep your airways clear of secretions.

Pain control

You may receive intravenous (IV) medications, an epidural or intercostal pain blocks to relieve your pain. Your provider may combine approaches.

Pulmonary hygiene

Pulmonary hygiene is a term used for exercises and procedures that keep your lungs clear of secretions. Your providers will work to keep you from developing pneumonia, which is the main complication of flail chest. Pulmonary hygiene is also known as pulmonary toilet or chest physiotherapy and may include:

• Suctioning to remove secretions from your airways.
• Incentive spirometry to help you improve your breathing.
• Bronchodilator therapy, or medications that open your airways.
• Fluid monitoring. It’s important to have the right amount of fluid in your blood so your lungs work correctly.
• Proper positioning to improve breathing and lessen pain.

Your provider may use continuous airway positive pressure (CPAP) or supplemental oxygen instead of mechanical ventilation to help you breathe. You may have to be on a ventilator to help you breathe until the trauma heals.

You may have to have surgery to prevent complications such as pneumonia, very long hospital stays or even death. This surgery is known as surgical rib fixation. There are various types of implanted devices used to keep your ribs stable.

After you begin recovering, you’ll still need to follow some suggestions for pulmonary hygiene. This may include breathing exercises such as pursed lip breathing and diaphragmatic (belly) breathing, along with ways of positioning your body.

How can I reduce my risk of flail chest?

You may reduce your risk of flail chest by reducing your risk of trauma. Drive safely, and always use your seat belt.

If you’re at risk of falling, make sure your floors are clear, you have enough light and you always use any walking aids you need, such as a walker or a cane.

What can I expect if I have flail chest?

If you have flail chest, you can expect to spend time in the hospital. Some studies have shown your length of stay in the intensive care unit (ICU) and in the hospital can be lower if you have surgical rib fixation.

It can take months to recover from flail chest and the trauma that caused it. You may continue to have difficulty breathing even after you’ve left the hospital.

How do I take care of myself?

You can expect to be in the hospital for some time if you have flail chest. You may not be able to take care of yourself for a while.

When you’re able to do so, you should follow the suggestions of your healthcare provider regarding breathing exercises, controlled coughing and other methods of reducing secretion buildup in your lungs.

Is flail chest the same as a pneumothorax?

No. Flail chest and pneumothorax aren’t the same thing.

A pneumothorax is also called a collapsed lung. The air goes between your chest wall and your lung rather than into your lung. You may have a pneumothorax as a complication of flail chest.

How serious is flail chest?

Flail chest is very serious. It can be fatal. It must be treated medically.

A note from Cleveland Clinic

Flail chest is a life-threatening medical emergency that happens as a result of trauma. If you have flail chest, it will take some time to recover. You'll be in the hospital for a long time. You may be on a ventilator for days. Even after you begin to recover, you’ll need to continue breathing exercises.