Flail Chest

Flail chest is when three or more ribs that are next to each other break in two or more places. This makes your chest wall become unstable and causes breathing problems.

The broken ribs cause paradoxical chest movements. That means the injured part of your chest wall moves in the opposite direction of your healthy chest wall. It’s very painful.

Other names for flail chest include:

• Chest wall instability
• Chest wall deformity

Flail chest is life-threatening. Call 911 or go to the nearest emergency room (ER) as soon as possible if you have a chest injury and problems breathing.

What are the symptoms of flail chest?

Symptoms may include:

• Severe chest pain
• Shortness of breath
• Bruising or swelling
• Blue skin, lips or nails

What causes it?

Blunt force trauma is the most common cause of flail chest. This commonly occurs from:

• Motor vehicle crashes
• Falls
• Sports injuries

Risk factors

Anyone can get flail chest. But you’re at a higher risk if you:

• Don’t wear a seat belt while driving or riding in a vehicle
• Have a condition that affects your bone strength, like osteoporosis or brittle bone disease
• Play high-impact sports like hockey, lacrosse, wrestling, mixed martial arts or football
• Have fall risks, including vision loss, lower body weakness and dizziness

What are the complications?

Flail chest complications may include:

• Pneumonia
• Collapsed lung
• Long-term pain
• Changes in the shape or structure of your chest wall
• Internal bleeding
• Lung bruising (pulmonary contusion)
• Tiredness or a faster loss of energy during physical activity

How doctors diagnose flail chest

Your healthcare provider will look at your injured area when you breathe. If you have flail chest, the outline of your chest will pop out more when you breathe out and go in farther when you breathe in. Your provider may also gently touch your ribs to feel for breaks.

They may also order chest X-rays to get a closer look at your broken ribs and check for any bruising to your lung.

How is flail chest fixed?

Getting oxygen and managing your pain are the first steps in treatment.

Your healthcare providers may use a CPAP machine or supplemental oxygen to help you breathe. In severe cases, you may need to be on a ventilator until you’re healthy enough to breathe on your own.

For pain management, your provider may give you IV medications, an epidural or intercostal nerve blocks.

You’ll also need pulmonary toilet to help keep your lungs clear of mucus and other secretions. Pulmonary toilet helps prevent pneumonia.

In severe cases, flail chest treatment may require surgical rib fixation. During this procedure, a surgeon uses metal plates to hold your ribs in place until they can heal.

What happens if it’s left untreated?

Without treatment, flail chest may cause:

• Long-lasting breathing problems
• Internal bleeding
• Respiratory failure, which may be fatal

How long does it take to heal?

It can take months to recover from flail chest. It’s common to stay in the hospital for up to two weeks, including intensive care for up to a week.

When should I see my healthcare provider?

Get immediate medical help if you have chest trauma and experience:

• Weakness or dizziness
• Trouble breathing or coughing
• Coughing up mucus or blood

What is the prognosis for flail chest?

Your outlook is good if you get medical treatment quickly. The faster you get medical treatment, the better your chances of making a complete recovery. Your prognosis also depends on your overall health and whether you develop complications.

You may continue to have breathing problems even after you leave the hospital. Your healthcare provider will let you know when it’s safe to return to school/work and do physical activity.

What is the most common cause of death?

Lung bruising commonly occurs alongside flail chest. Without quick treatment, lung bruising may cause sudden respiratory failure, which may be fatal.

Can flail chest be prevented?

You can help reduce injuries to your chest by:

• Always wearing your seatbelt, even if you’re a passenger
• Using walking aids (cane, walker) if you have trouble walking
• Making sure your home is free of tripping hazards, like clutter
• Having proper lighting in your home
• Using secure ladders or step stools, not chairs or tables, to reach high places
• Promoting bone health