What is a Flail Chest?
A flail chest occurs when a segment of the thoracic wall becomes unattached from the rest of the chest wall. This most typically occurs when ribs are fractured in two places, allowing that segment of the thoracic wall to "float" independently of the rest of the chest wall. Flail chest can also occur when ribs are fractured proximally in conjunction with disarticulation of costochondral cartilages distally. In very young animals in whom the costal cartilages are quite flexible, a flail chest can occur when several ribs are fractured proximally and the costal cartilages allow the segment to move independently of the rest of the chest wall.
"Paradoxical chest wall motion" best describes a flail chest.
Paradoxical chest wall motion in a flail chest:
How should a flail chest be treated?
Treatment of flail chest is dictated by the clinical condition and degree of respiratory distress.
Local anesthetic block of the affected ribs (Bupivicaine instillation caudal to the affected ribs at the rib origin) will decrease the patient's pain.
If the flail segment is impairing gas exchange or contributing to hypoxemia, the flail segment should be supported by a firm chest wrap or temporarily by laying the patient with the flail segment down against the exam table. This prevents the flail segment from moving out paradoxically during expiration.
Oxygen supplementation may be necessary depending on the underlying lung pathology.
Surgical stabilization of the flail segment is rarely necessary.
Return to Respiratory Distress