The Management of Flail Chest

Flail chest is an uncommon consequence of blunt trauma. It usually occurs in the setting of a high-speed motor vehicle crash and can carry a high morbidity and mortality. The outcome of flail chest injury is a function of associated injuries. Isolated flail chest may be successfully managed with aggressive pulmonary toilet including facemask oxygen, continuous positive airway pressure, and chest physiotherapy. Surgical stabilization is associated with a faster ventilator wean, shorter ICU time, less hospital cost, and recovery of pulmonary function in a select group of patients with flail chest. There is no role for stabilization for patients who have severe pulmonary contusion. Supportive therapy and pneumatic stabilization is the recommended approach for this patient subset.