All of the following are true regarding flail chest, EXCEPT:

Flail chest arises whenever a poion of the chest wall becomes completely discontinuous from the rest of the rib cage. It occurs when three or more contiguous ribs are fractured in at least two locations bilaterally. Paradoxical chest wall movement may not be seen in a conscious patient due to splinting of the chest wall. Patients who are able to maintain adequate oxygenation and ventilation with supplemental oxygen may be maintained without mechanical ventilation and endotracheal intubation, paicularly if adequate pain control can be achieved. Emergency thoracotomy is not required for treating flail chest. Also, mechanical fixation of the rib fractures usually is not necessary. Ref: Ali J. (2005). Chapter 95. Torso Trauma. In J.B. Hall, G.A. Schmidt, L.D. Wood (Eds), Principles of Critical Care, 3e.