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Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
Ph: (818) 409-8000

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What is a flail chest? Our 16-year-old son was involved in a serious car wreck. He's in the operating room with multiple injuries. They say the worst is this flail chest.

Flail chest describes a condition in someone with four (or more) rib fractures in a row. To meet the criteria for a diagnosis of flail chest, each rib must be broken in at least two places. Breathing is altered such that as the person breathes in, the chest wall collapses instead of expanding. As the patient breathes out, the opposite happens: the chest wall expands instead of contracting. This breathing pattern is described as paradoxical. Flail chest with paradoxical breathing are risk factors for loss of adequate lung function called pulmonary insufficiency. Flail chest can cause contusion (bruising or injury) of the lung(s) and collapse of the individual ventilation units of the lungs (the alveoli). As you might imagine, the inability to breathe normally has huge consequences. These patients often end up on a mechanical ventilator (machine that breathes for them). The most common cause of flail chest is severe chest wall injury with rib fractures as a result of major trauma such as a car or motocycle accident or a crush injury. CT scans are used to identify the full extent of rib injury. The CT scan is much more sensitive than X-rays in giving a three-dimensional (3-D) view of rib fractures. Identifying rib fractures is important because they can become displaced (separate and shift in position). That's when nerves, blood vessels, organs, and soft tissues can be damaged creating further problems. As serious as this condition sounds, it is not always treated with surgery. Studies show that some patients do need open reduction and internal fixation (ORIF). In this procedure, the chest is opened and the ends of the displaced bones are brought together and held in place until healing occurs. There's no clear cut list of what type of patients will need operative care -- it's going to depend on the pattern of fracture, the patient's age, general health and overall medical condition, and symptoms.


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