If you are able to breathe normally without any problem, you should be grateful and understand that it is indeed a blessing in disguise. Do you know how many people are unable to breathe with ease? It is estimated that at least 10 to 25% middle-aged and older people have breathlessness. Breathlessness itself is a dominant symptom of many diseases related to heart and respiration. In the world of medicine, conditions such as flail chest can cause significant breathing problems and can be life-threatening.
Flail chest is a type of injury caused by blunt trauma to the chest. It is a condition referring to the chest wall that moves in the opposite direction to the rest of the chest (thorax). Flail chest is resulted from three or more rib fractures in at least 2 places. Flail chest often occurs on one side of the chest but may occur on both sides of the chest. While it is true that most flail chest injuries are caused by blunt trauma such as with motor vehicle collisions, in the elderly, falls can contribute to flail chest. Elderly are susceptible to flail chest merely from fall as the chest walls are stiff, there is lung disease or osteoporosis itself. Children with metabolic bone disease and osteogenesis imperfecta can easily have a flail chest.
To understand better how serious a flail chest can be, it is best to understand the normal chest first. Chest is the part of the body located between the neck and the abdomen. Chest is also known as thorax. The thoracic cavity is the 2nd largest hollow space of the human body, behind the abdominal cavity. It is enclosed by the 12 pairs of ribs, the vertebral columns and breastbone or better known as sternum. Ribs play an important role in protecting vital organs and maintaining space within the chest. This open space enables the lung to expand and deflate that is needed in the breathing process. In normal respiration, humans breathe in air during inspiration, causing the chest wall to expand and move outward. Those with flail chest will show segments (part) of the chest moving paradoxically such as outward during expiration and inward during inspiration.
Main symptom of flail chest is the paradoxical breathing. Due to the fact that it is caused by fracture and trauma, pain can be felt at the fractured sites when moving the chest. This includes when breathing, sneezing and coughing. Some people may show abnormal breathing patterns of short and swallow breath in an attempt to reduce pain. Pain is resulted from the muscle pulling the injured area during breathing. Serious breathing difficulties can occur as the lungs are unable to function normally due to the injury causing the affected area to lose structure and leave lungs with small spaces when breathing. Similar to other injuries, inflammation sign as tenderness and bruising can be seen on the chest affected by the blunt trauma.
Due to the fact that flail chest is a serious condition, it is important for those with symptoms to get evaluated by medical professionals as soon as possible. When left untreated, it not only causes disability but can lead to immediate death. Treatment aims to maintain ventilation with oxygen and a stable chest wall. Initial treatment involves splinting by placing pressure on the affected areas, fluid therapy, oxygenation and managing pain. In severe cases, patients may need to be intubated and put on a ventilator. Pain management includes nerve blocks or epidural anaesthesia to address the pain early on. Surgery is recommended to stabilise the ends of the fractured ribs or any displaced ribs. Surgery may also be needed in cases such as those unable to get off from the ventilator, respiratory failure despite adequate pain management or those requiring thoracotomy for other reasons.
Flail chest is easily diagnosed when there is obvious paradoxical chest wall motion. Most flail chest is found in emergency settings, making it most obvious after a history of blunt trauma. Symptoms can be seen almost immediately. Doctors may request imaging tests such as chest CT scan or X-ray to get a closer look of the chest structure.
Flail chest may seem like a definite threat to a human life but it accounts for 10 to 20% of mortality rate. Most who died are not from flail chest alone as it is often associated with other organ injury. Most patients may take at least 6 months and up to a year before they are fully recovered. Some patients may continue to feel chest pain for many years. Physiotherapy such as physical therapy can help patients breathe better and ease symptoms. Physical therapy is provided when a patient is stable. Physiotherapy can prevent loss of muscle mass and muscle contracture.
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In essence, flail chest is a condition where there are three or more fractured ribs that cause paradoxical movements of the chest. Most flail chest is caused by blunt trauma. Paradoxical breathing and pain to the affected area are among the common signs and symptoms of flail chest. It is important for a flail chest to get evaluated by medical professionals and get treated appropriately.
