Rib Fractures


Epidemiology

General Demographics

  • Rib Fractures are Present in 10% of All Trauma Patients (Eur J Cardiothorac Surg, 2003) [MEDLINE]
    • Rib Fractures are Present in 30% of Trauma Patients with Significant Chest Trauma
    • The Number of Fractured Ribs Correlates with the Extent of Intrathoracic Injury

Demographic Data for Flail Chest

  • Flail Chest Occurred in 5-13% of Patients with Chest Wall Injury (National Trauma Data Bank, 2012) (J Trauma Acute Care Surg, 2014) [MEDLINE]
  • Flail Chest Occurred in 1% of All Patients Admitted to Level ½ Trauma Centers (National Trauma Data Bank, 2012) (J Trauma Acute Care Surg, 2014) [MEDLINE]
  • Mean Age: 52.5 yrs (National Trauma Data Bank, 2012) (J Trauma Acute Care Surg, 2014) [MEDLINE]
  • Male Sex-Predominance: 77% of flail chest cases were male (National Trauma Data Bank, 2012) (J Trauma Acute Care Surg, 2014) [MEDLINE]
  • Concomitant Injuries
    • Approximately 15% of Flail Chest Cases Had Coexisting Head Injury (National Trauma Data Bank, 2012) (J Trauma Acute Care Surg, 2014) [MEDLINE]
    • Approximately 54% of Cases Had Coexisting Lung Contusion (National Trauma Data Bank, 2012) (J Trauma Acute Care Surg, 2014) [MEDLINE]

Etiology

Physiology

Flail Chest (“Stoved-In Chest”, Crushed Chest)

Sternal Flail

Diagnosis

Chest X-Ray (see Chest X-Ray, Chest X-Ray)

Chest CT (see Chest Computed Tomography, Chest Computed Tomography)

Thoracic Ultrasound (see Thoracic Ultrasound, Thoracic Ultrasound)

Clinical Manifestations

Pulmonary Manifestations

Concomitant Traumatic Injuries

Long-Term Complications

Treatment

Triage/Need for Hospitalization

Background

Recommendations

Pulmonary Toilet

Fluid Management

Recommendations for Management of Pulmonary Contusion/Flail Chest (Eastern Association for the Surgery of Trauma, EAST, Practice Guideline) (J Trauma Acute Care Surg, 2012) [MEDLINE]

Analgesia

Non-Regional Analgesia

Regional Analgesia/Anesthesia Techniques

Recommendations for Management of Pulmonary Contusion/Flail Chest (Eastern Association for the Surgery of Trauma, EAST, Practice Guideline) (J Trauma Acute Care Surg, 2012) [MEDLINE]

Recommendations for Blunt Thoracic Trauma (Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society) (J Trauma Acute Care Surg, 2016) [MEDLINE]

Venous Thromboembolism Prophylaxis

Antibiotics

Mechanical Ventilation

Recommendations for Management of Pulmonary Contusion/Flail Chest (Eastern Association for the Surgery of Trauma, EAST, Practice Guideline) (J Trauma Acute Care Surg, 2012) [MEDLINE]

Surgical Stabilization

Recommendations for Management of Pulmonary Contusion/Flail Chest (Eastern Association for the Surgery of Trauma, EAST, Practice Guideline) (J Trauma Acute Care Surg, 2012) [MEDLINE]

Recommendations for Blunt Thoracic Trauma (Eastern Association for the Surgery of Trauma) (J Trauma Acute Care Surg, 2017) [MEDLINE]

Other

Recommendations for Management of Pulmonary Contusion/Flail Chest (Eastern Association for the Surgery of Trauma, EAST, Practice Guideline) (J Trauma Acute Care Surg, 2012) [MEDLINE]

Prognosis

Prognosis is Related to Number of Rib Fractures

Mortality Rate for Flail Chest

References

General

Treatment