True about Flail chest

A flail chest results from blunt trauma associated with multiple rib fractures, i.e. three or more ribs fractured in two or more places. The diagnosis is made clinically,not by radiography.On inspiration the loose segment of the chest wall is displaced inwards and on expiration,it is displaced outwards-paradoxical respiration. Voluntary splinting as a result of pain, mechanically impaired chest wall movement and the associated lung contusion are all causes of the hypoxia. The patient is also at high risk of developing a pneumothorax or haemothorax. Traditionally, treatment consisted of mechanical ventilation to 'internally splint' the chest until fibrous union of the broken ribs occurred. The price for this was considerable in terms of intensive care unit resources and ventilation dependent morbidity. Currently, treatment consists of oxygen administration, adequate analgesia (including opiates) and physiotherapy. If a chest tube is in situ, intrapleural local analgesia can be used as well. Ventilation is reserved for cases developing respiratory failure despite adequate analgesia and oxygen. Surgery to stabilise the flail chest is currently in use again. Reference:Bailey & Love's sho practise of surgery,25th edition,page no:343.