Most common chest wall injury (others include sternum and clavicle)
Clinical diagnosis mainly. Can use CXR to check for lung injury but may not be able to see fractures/all ribs.
Can have underlying lung injury resulting in pneumothorax, haemothorax, pulmonary contusion.
Management is mainly pain control – paracetamol/NSAIDS/opioids. Or use epidural, intercostal nerve blocks, PCA,
Flail chest
Flail chest – 2 or more ribs broken at 2 or more places – a segment of chest wall moves paradoxically with respiration.
Clinical diagnosis in ‘B’ of ATLS (life-threatening ATOMFC injuries) – confirm with CT chest.
Respiratory compromise and pulmonary injury inevitable (as above).
Management is give oxygen, ventilatory support, pain control (as above) and chest physiotherapy. Can also be fixed by ORIF of flail segment, but ?benefit.