Contemporary management of flail chest

Am Surg. 2014 Jun;80(6):527-35. doi: 10.1177/000313481408000613.


Thoracic injury is currently the second leading cause of trauma-related death and rib fractures are the most common of these injuries. Flail chest, as defined by fracture of three or more ribs in two or more places, continues to be a clinically challenging problem. The underlying pulmonary contusion with subsequent inflammatory reaction and right-to-left shunting leading to hypoxia continues to result in high mortality for these patients. Surgical stabilization of the fractured ribs remains controversial. We review the history of management for flail chest alone and when combined with pulmonary contusion. Finally, we propose an algorithm for nonoperative and surgical management.

Publication types

  • Review

MeSH terms

  • Disease Management*
  • Flail Chest* / diagnosis
  • Flail Chest* / etiology
  • Flail Chest* / surgery
  • Fracture Fixation, Internal / methods*
  • Humans
  • Injury Severity Score
  • Rib Fractures* / complications
  • Rib Fractures* / diagnosis
  • Rib Fractures* / surgery
  • Tomography, X-Ray Computed