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The Nonoperative Management of Flail Chest Injury

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Injuries to the Chest Wall

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Abstract

Thoracic injury stands second only to head and spine injury when accounting for patient mortality in trauma [LoCicero and Mattox (Surg Clin North Am 69:15–19, 1989)]. Flail chest is one of the severe forms of thoracic trauma. It is defined as the presence of ≥3 unilateral segmental rib fractures or ≥3 bilateral rib fractures or ≥3 unilateral fractures combined with sternal fracture/dissociation [Kaiser (Thoracic trauma. Surgical foundations, essentials of thoracic surgery, 2004); Nirula et al. (World J Surg 33:14–22, 2009)]. Morbidity caused by a flail chest injury is based upon loss of continuity of the flail segment from the thoracic cage causing impaired respiratory movement and gas exchange mechanisms. The accompanying pulmonary lesion plays an important role in determining long-term outcome and residual damage to the lung. Management of flail chest, therefore, cannot be standardized and needs to be individualized based upon the nature of accompanying injuries. For those patients who do not meet specific operative indications, advances in the nonoperative care of flail chest injuries have improved outcomes: many of these innovations and techniques also benefit those patients who have undergone operative stabilization. This chapter will discuss the investigation, treatment (medication, analgesia, ventilation), and outcome of the nonoperative treatment of the patient with a flail chest.

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Authors and Affiliations

  1. Department of Critical Care, St. Michael’s Hospital, Toronto, ON, Canada

    Shalini Nair M.D., Akhilesh Tiwari M.D. & Andrew Baker M.D., F.R.C.P.C.

  2. Departments of Anesthesia and Surgery, University of Toronto, Toronto, ON, Canada

    Andrew Baker M.D., F.R.C.P.C.

Authors
  1. Shalini Nair M.D.
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  3. Andrew Baker M.D., F.R.C.P.C.
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Correspondence to Shalini Nair M.D. .

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Editors and Affiliations

  1. Division of Orthopedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada

    Michael D. McKee

  2. Division of Orthopedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada

    Emil H. Schemitsch

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Nair, S., Tiwari, A., Baker, A. (2015). The Nonoperative Management of Flail Chest Injury. In: McKee, M., Schemitsch, E. (eds) Injuries to the Chest Wall. Springer, Cham. https://doi.org/10.1007/978-3-319-18624-5_5

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  • DOI: https://doi.org/10.1007/978-3-319-18624-5_5

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-18623-8

  • Online ISBN: 978-3-319-18624-5

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