Flail Chest
Jennifer Lohmus
Clinically Relevant Anatomy
[edit | edit source]
add text here relating to clinically relevant anatomy of the condition
Pathophysiology[edit | edit source]
“A break in the structural continuity of the bone” that can be caused by trauma, stress and pathological factors. (Apley, Solomon, Warwick, Nayagam & Apley, 2005)
Types:
- Complete
- Incomplete
- Physeal
Classification according to the nature of the fracture:
- Spiral
- Transverse
- Comminuted
- Compression
Associated conditions:[edit | edit source]
Pulmonary complications 48-72 hours after admission (Battle, Hutchings, James, & Evans, 2013):
- haemothorax
- pneumothorax
- atelectasis
- pneumonia
- pleural effusion
- subcutaneous emphysema
- ARDS,
- pulmonary emboli
- aspiration
- lobar collapse
Risk factors for developing associated conditions (Battle, Hutchings, James, & Evans, 2013):
- >65 years old
- >3 rib fractures
- Hx. of chronic lung conditions or CVD
- Pre-injury anti-coagulant use
- <90% SpO2
Clinical Presentation[edit | edit source]
Flail segment is a portion of the rib cage that breaks due to trauma and becomes unattached from the chest wall. (Pettiford, Luketich & Landreneau, 2007).
Diagnostic Procedures[edit | edit source]
add text here relating to diagnostic tests for the condition
Outcome Measures[edit | edit source]
Physiotherapy Management / Interventions[edit | edit source]
Chest physiotherapy management consists of the following (May, Hillermann & Patil, 2016):
1. Ventilatory Management - supplemental oxygen therapy, continuous positive airway pressure or intubation if necessary
- CPAP - for negative intrapleural pressure and paradoxical movement, increases TV (May, Hillermann & Patil, 2015)
- Open/closed suction if patient intubated (Berney, Haines & Denehy, 2012)
2. Pain Management and Education
- Education on fracture healing
3. Early mobilization if possible
- Transfers to sitting out of bed
- Mobilization 2-3x daily and SOOB 3-4x/day
4. Chest and airway clearance techniques (if inadequate)
- ACT: nebulizer with ACBT and education
- Bubble PEP or Flutter
5. Deep breathing exercises and supported coughing technique
- Supported Cough: Wrap around technique or rolled up towel
- DBE/TEE’s with SMIs (2-4 secs hold)
6. Positioning
- Positioning in side lying and high sitting (Berney, Haines & Denehy, 2012)
Medical Management[edit | edit source]
Medications: (May, Hillermann & Patil, 2016)
- Simple Analgesics
- Opioids
- Patient Controlled Analgesia
- Operative fixation and Regional Anaesthetic
Surgery:
Conservative (May, Hillermann & Patil, 2016)
- Regional anaesthesia
- Serratus anterior block
- Paravertebral block
- Thoracic epidural
Differential Diagnosis[edit | edit source]
add text here relating to the differential diagnosis of this condition
Resources[edit | edit source]
https://www.rch.org.au/trauma-service/manual/chest-injury/
https://www.wcpt.org/wcpt2017/FS-01
References[edit | edit source]
Battle C, Hutchings H, Evans PA. Blunt chest wall trauma: A review. Trauma. 2013;15(2):156-75.
Jena R, Agrawal A, Sandeep Y, Shrikhande N. Understanding of flail chest injuries and concepts in management. International Journal of Studentsí Research. 2016;6(1):3-5.
May L, Hillermann C, Patil S. Rib fracture management. BJA Education. 2016;16(1):26-32.
Pettiford BL, Luketich JD, Landreneau RJ. The Management of Flail Chest. Thoracic Surgery Clinics. 2007;17(1):25-33.
Solomon L. Apley's concise system of orthopaedics and fractures. 3rd ed.. ed. Warwick D, Nayagam S, Apley AG, editors. London : New York: London : Hodder Arnold New York : Distributed in the United States by Oxford University Press; 2005.
