Flail chest is an injury that occurs typically following a blunt trauma to the chest. When three or more ribs in a row have multiple fractures within each rib, it can cause a part of your chest wall to become separated and out of sync from the rest of your chest wall. It’s considered an emergency, as there could be a severe associated lung injury, and it’s imperative that you’re treated immediately.
It’s rare for this to occur as a consequence of chest trauma, but when it does happen, flail chest can severely affect your ability to breathe and cause you considerable health concerns.
What are the symptoms?
Flail chest can present very differently depending on how serious a case it is. If you’ve had a severe trauma to the chest you should look out for these common symptoms:
- extreme pain in your chest
- tenderness in the area of your chest where the bone has come away
- significant difficulty in breathing
- bruising and inflammation
- uneven rising or falling of your chest when breathing
The chest moving unevenly between the separated part and rest of the chest is often the most definitive sign that you have a flail chest. The area of your chest that’s been traumatized will draw in when you breathe in, while the rest of your chest expands outward. When you breathe out, the affected area will expand out while the rest of your chest draws in.
Chest wall blunt trauma is the cause of flail chest. It's called chest wall blunt trauma because it's the result of a blunt or flat object hitting the chest wall, destabilizing it and leaving it "floating". It’s common for trauma to the chest to occur during road accidents. This trauma can vary in severity from minimal bruising to fracture of the ribs. Trauma to the chest acquired during a road accident is usually the result of a blunt or flat object, like a steering wheel, hitting the chest wall without penetrating the skin.
This type of injury can also be caused by CPR chest compressions or traumatic injuries such as getting kicked by an animal.
Rib fractures that are caused by blunt traumas can be very painful, as the muscles that we use to breathe continue to pull on the injury. Ribs that have been fractured by a blunt trauma may also cause further injuries, like punctured lungs or damaged blood vessels.
Flail chest is one of the most severe outcomes of a blunt trauma to your chest wall.
How is it diagnosed?
A flail chest is diagnosed by physical examination from your doctor, just as any other rib fracture would be. If they see an unusual movement of your chest wall while you breathe, it’s a clear sign that you may have a flail chest.
They will then typically send you for a chest X-ray to confirm their diagnosis. Although some rib fractures aren’t visible on plain film X-ray studies, severe injuries caused by blunt trauma, like flail chest, can usually be seen at some point. You might need to have more than one X-ray taken in order to detect your injury.
Flail chest is an extremely severe injury, and it’s imperative that you’re treated immediately. Your doctors will need to protect your lungs while ensuring that you can breathe adequately. They will give you an oxygen mask to assist your breathing and give you medication to help with your pain.
In more serious cases where there is associated underlying lung injury, you may need to be put on a mechanical ventilator in order to keep your chest cavity stable. It’s possible that surgery will be required, depending on the extent of injury and risks versus benefits of surgery.
Recovering from a flail chest
The recovery time for a flail chest injury varies greatly. Your recovery will entirely depend on the type of injury, its location, and whether you developed any complications. People whose injuries are on the less severe end of the spectrum may make a full recovery in six weeks. People whose injuries are much more significant may take a year to recover. Many people who have experienced a flail chest continue to have problems for life.
There is a greater risk for long-term disability for people who experience a flail chest. Long-term problems include persistent pain in the chest wall, deformity of the chest, and shortness of breath after exertion. In some cases, however, people are able to regain normal lung function within six months, even if there is still a deformity in the chest.
Prognosis and outlook
Immediate treatment for flail chest is required to prevent it from threatening your life. It’s an extremely serious condition.
Younger people who are in good health can usually recover without experiencing further complications, if the correct treatment is administered promptly. But older adults have a greater risk of complications, such as pneumonia or respiratory failure.
In the most extreme cases, where a portion of the chest wall collapses and there is severe underlying lung or blood vessel trauma inside the chest cavity, the chances of survival are low, even where treatment is sought immediately.
However, in many cases of flail chest, where the injury is less severe and complications do not arise, it’s possible for people to recover in a few weeks or months if they receive the appropriate treatment.