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Background: Traumatic flail chest results in respiratory distress and prolonged hospital stay. Timely surgical fixation of the flail chest reduces respiratory complications, decreases ventilator dependence, and shortens hospital stays. Concomitant head injury is not unusual in these patients and can postpone surgical timing due to the need to monitor the status of intracranial injuries. Reducing pulmonary sequelae also assists in the recovery from traumatic brain injury and improves outcomes. No previous evidence supports that early rib fixation can improve the outcome of patients with concomitant flail chest and traumatic brain injury. Research Question: Can early rib fixation improve the outcome of patients with concomitant flail chest and traumatic brain injury? Study Design and Methods: Adult patients with blunt injuries from the Trauma Quality Improvement Project between 2017 and 2019 were eligible for inclusion. Patients were divided into two treatment groups: operative and nonoperative. Inverse probability treatment weighting was used to identify the predictors of mortality and adverse hospital events. Results: Patients in the operative group had a higher intubation rate [odds ratio (OR), 2.336; 95% CI, 1.644-3.318; p < 0.001), a longer length of stay (coefficient ß, 4.664; SE, 0.789; p < 0.001), longer ventilator days (coefficient ß, 2.020; SE, 0.528; p < 0.001), and lower mortality rate (OR], 0.247; 95% CI, 0.135-0.454; p < 0.001). Interpretation: Timely rib fixation can improve the mortality rate of patients with flail chest and a concomitant mild-to-moderate head injury. [ABSTRACT FROM AUTHOR]

Rib fracture is the most common injury in chest trauma. Most of patients with rib fractures were treated conservatively, but up to 50% of patients, especially those with combined injury such as flail chest, presented chronic pain or chest wall deformities, and more than 30% had long-term disabilities, unable to retain a full-time job. In the past two decades, surgery for rib fractures has achieving good outcomes. However, in clinic, there are still some problems including inconsistency in surgical indications and quality control in medical services. Before the year of 2018, there were 3 guidelines on the management of regional traumatic rib fractures were published at home and abroad, focusing on the guidance of the overall treatment decisions and plans; another clinical guideline about the surgical treatment of rib fractures lacks recent related progress in surgical treatment of rib fractures. The Chinese Society of Traumatology, Chinese Medical Association, and the Chinese College of Trauma Surgeons, Chinese Medical Doctor Association organized experts from cardiothoracic surgery, trauma surgery, acute care surgery, orthopedics and other disciplines to participate together, following the principle of evidence-based medicine and in line with the scientific nature and practicality, formulated the Chinese consensus for surgical treatment of traumatic rib fractures (STTRF 2021). This expert consensus put forward some clear, applicable, and graded recommendations from seven aspects: preoperative imaging evaluation, surgical indications, timing of surgery, surgical methods, rib fracture sites for surgical fixation, internal fixation method and material selection, treatment of combined injuries in rib fractures, in order to provide guidance and reference for surgical treatment of traumatic rib fractures. [ABSTRACT FROM AUTHOR]

Surgical stabilization of the flail chest is challenging and has no established guidelines. Chest wall integrity and stability are the main factors that ensure the protection of intrathoracic organs and an adequate respiratory function. Here, we report a novel chest wall reconstruction technique in a 45-year-old man with a traumatic left flail chest and open pneumothorax diagnosed both clinically and radiographically. Rib approximation and chest wall reconstruction was done using intercostal figure-of-eight suture and polypropylene mesh with vascularized musculofascial flap. The patient improved gradually and was discharged after three weeks of total hospital stay. He returned to regular working after a month with no evidence of respiratory distress or paradoxical chest movement. Follow-up visit at one year revealed no lung hernia or paradoxical chest movement. This is a novel, feasible and cost-effective modification of chest wall reconstruction that can be adopted for thoracic wall repair in case of open flail chest, which needs emergency surgical interventions even in resource constraint settings. [ABSTRACT FROM AUTHOR]

Background: There are still controversies between surgical treatment and conservative treatment for multiple rib fractures (MRFs). No consensus has been reached concerning the indications and timing of surgery. In this meta-analysis, we aimed to determine the optimal treatment for MRFs.Methods: Six databases (PubMed, Medline, Embase, Cochrane, Cnki, Wanfang Database) were retrieved for all eligible randomized controlled trials (RCTs) published before January 2020. MRFs were treated either with operative reduction and internal fixation or conservative treatment. The pertinent data were retrieved. The quality of RCTs was evaluated by the modified Jadad rating scale and meta-analysis was performed using RevMan 5.3 software.Results: Seven RCTs involving 538 MRFs patients (260 were treated surgically vs. 278 conservatively) were included in this meta-analysis. Compared with conservative treatment, surgical treatment resulted in shorter length of hospital stay (WMD -8.48; 95% CI -11.34 to -5.63; P < 0.001), length of ICU stay (WMD -5.72; 95% CI -7.31 to -4.13; P < 0.001) and duration of mechanical ventilation (WMD -4.93; 95% CI -8.79 to -1.07; P = 0.01), with a lower risk of complications including pneumonia (RR 0.40; 95% CI 0.30 to 0.53; P < 0.001) and chest wall deformity (RR 0.07; 95% CI 0.03 to 0.14; P < 0.001). The sensitivity analysis carried out by excluding one study with significant heterogeneity showed that the rate of tracheostomy was lower in the surgical group than in the conservative group (RR 0.44; 95% CI 0.28 to 0.71; P = 0.0008).Conclusions: For patients with MRFs, surgical treatment resulted in faster recovery, a lower risk of complications and better prognosis than conservative treatment. [ABSTRACT FROM AUTHOR]

Background/purpose: The combination of ipsilateral floating shoulder and flail chest is a unique injury pattern that has not been previously described in the literature. We termed the injury pattern floating flail chest (FFC). The purpose of this study was to evaluate the effect of operative treatment of the shoulder girdle component to overall hospital length of stay (LOS). Methods: Forty-one patients were enrolled between two level I trauma centers identifying with a combination ipsilateral floating shoulder and flail chest injury, 23 treated with operative stabilization and 18 treated non-operatively. This retrospective cohort study evaluated the overall LOS and intensive care unit (ICU) days. Results: The operative group had decreased overall LOS (10.1 vs. 19.8 days, p = 0.02) and decreased ICU days (3.4 vs. 10.3, p = 0.04). Conclusion: This study describes a unique injury pattern that combines the floating shoulder and flail chest, FFC. Our study suggests that operative treatment of the shoulder girdle may decrease both overall LOS and ICU days in patients with FFC. [ABSTRACT FROM AUTHOR]

• Surgical stabilization of flail chest lead to fast weaning from mechanical ventilation. • Plates can be used for stabilization of sterno-costal dehiscence. • Cartilage reconstruction of a CT scan can reveal the true severity of the trauma. Flail chest is diagnosed clinically by the presence of paradox movement of a segment of the thoracic wall during spontaneous breathing. Radiographic finding confirming a clinical flail chest are fractures of three or more consecutive ribs or costal cartilages in two or more places. Surgical stabilization is associated with a reduced length of hospital stay, time with mechanical ventilation and risk of respiratory complications. A trauma patient had a Computed Tomography (CT) scan showing multiple costa fractures, sternal fracture, manubrium fracture, sternal displacement and dehiscence of the sternal-costal attachment. The severity of the trauma was visualized after performing a cartilage reconstruction of the trauma CT scan. The patient underwent surgery, using fixation plates to stabilize the thoracic cage, and was then weaned quickly from mechanical ventilation. This case indicates, that if a patient has a severe flail chest recognized clinically, but not radiologically, a reconstruction of cartilage can reveal the true severity of the trauma. Indeed, the patient in this case experienced a positive outcome from surgery. However, such a procedure demands correct timing and experience in surgical stabilization of the thoracic wall. Furthermore, the injury required accurate planning with the involved personal before surgery. Surgical stabilization of advanced flail chest with concomitant sternal fracture, seems to be a safe procedure, that might reduce the need of mechanical ventilation and the length of stay at the Intensive Care Unit (ICU). Furthermore, cartilage reconstruction of the trauma CT scan can potentially identify a severe flail chest, that might be missed on regular 3D bone reconstruction. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medica Herediana is the property of Universidad Peruana Cayetano Heredia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction We present short and long term outcomes of titanium rib plating in two pediatric patients with traumatic flail chest. Cases Patient 1 is a 12 year old male ATV driver with left thorax handlebar impalement with a flail segment of ribs 4–8. He was unable to wean from the ventilator by hospital day (HD) 4 and had titanium plating of ribs 4–7. He was extubated on postoperative day (POD) 1 and discharged home on POD 5. He returned to contact sports at 6 months. Patient 2 is a 13 year old male dirt bike rider with fractures of left ribs 8–12, including a 9–10 flail segment. He was unable to wean from the ventilator by HD 3 and had titanium plating of ribs 8–10. He was extubated on POD 2 and discharged on POD 11. After 4 months of therapy, he returned to full activity. Conclusions In these two patients, flail chest resulted in failure to wean from the ventilator. Plating of the flail segment allowed ventilator weaning, improved pain control, and return to normal activity with minimal symptoms. Long-term outcomes show excellent cosmetic and functional results with symmetric chest wall growth (Table 1) Level of evidence IV. [ABSTRACT FROM AUTHOR]

The article presents a case study of 72-year-old man presented to the Emergency Department by ambulance following a rollover motor vehicle crash preceded by black-out symptoms. Topics discussed include suffering from dermatitis herpetiformis for the last six years and treated with dapsone and partially glutenfree diet; diagnosis of dapsone-induced methaemoglobinaemia alongside dapsone-induced oxidative haemolytic anaemia; and recommended ascorbic acid therapy.

Purpose: Flail chest (FC) injuries represent a significant burden on trauma services because of its high morbidity and mortality. Current gold standard conservative management strategies for FC, are now being challenged by renewed interest in surgical rib fixation. This retrospective epidemiological study sets out to evaluate FC patients, and quantify the natural history of this injury by studying the injury patterns, epidemiology and mortality of patients sustaining FC injuries admitted to a major trauma centre (MTC).Methods: A retrospective cohort analysis has been conducted at an MTC with full trauma service. All patients (age > 16 years) sustaining FC were included. Patient demographics, injury characteristics and inpatient stay information were extracted.Results: Two hundred and ninety-three patients were identified, with a mean injury severity score (ISS) of 28.9 (range 9-75), average age of 56.1 years (range of 16-100), and a male predominance (78%). Road traffic accidents accounted for 45% (n = 132) of injuries, whilst 44% were fall or jump from height (n = 129). Associated lung contusion was present in 133 patients (45%) while 76% of patients were found to have 5 or more ribs involved in the flail segment (n = 223) with 96% (n = 281) having a unilateral FC. Inpatient treatment was required 19.9 days (range 0-150 days) with 59% of patients (n = 173) requiring intensive care unit (ICU) level care for 8.4 days (range 1-63) with 61.8% requiring mechanical ventilation (n = 107) for 10.5 days (range 1-54), and 7.8% underwent rib fixation with rib plates (n = 23). The mortality rate was found to be 14% (n = 42). A non-significant trend towards improved outcomes in the conservative group was found when compared with the fixation group; ventilation days (6.94 vs 10.06, p = 0.18) intensive treatment unit (ITU) length of stay (LOS) (12.56 vs 15.53, p = 0.28) and hospital LOS (32.62 vs 35.24, p = 0.69).Conclusion: This study has successfully described the natural history of flail chest injuries, and has found a nonsignificant trend towards better outcomes with conservative management. With the cohort and management challenges now defined, work on outcome improvement can be targeted. In addition the comparability of results to other studies makes collaboration with other MTCs a realistic proposal. [ABSTRACT FROM AUTHOR]

This article discusses unique factors associated with rib fractures in the elderly patient population and explains the process used in one facility to develop a revised protocol for the management of elderly patients with a rib fracture. The goals were to eliminate gaps in early trauma care management and employ a care routine that would improve outcomes for this vulnerable group of patients with fracture. [ABSTRACT FROM AUTHOR]

Flail chest is a serious complication that may arise secondary to thoracic trauma and is associated with increased morbidity and mortality. In a flail chest, paradoxical chest movement decreases the functional residual capacity, leading to hypoxia, hypercapnia, and atelectasis. Adequate ventilation, fluid and pain management have classically been the cornerstones to flail chest treatment, with operative fixation being utilized in specific cases. Traumatic brain injury (TBI) has historically been believed to be an absolute contraindication for surgical fixation of rib fractures (SSRF); however, emerging studies have shown a favorable prognosis in select patients who underwent SSRF with severe TBI (Glasgow Coma Scale ≤8). A 66-year-old male was brought into the Emergency Department by EMS following a traumatic injury that resulted in multiple rib fractures, spinal fractures, and traumatic brain injury. On hospital day 3, the patient underwent SSRF to repair bilateral flail chest. SSRF stabilized cardiopulmonary physiology, improving this patient's hospital course and avoiding the need for a tracheostomy. Herein, we report the successful use of SSRF in a flail chest patient with severe TBI that improved outcomes without evidence of secondary brain injury. TBI is a severe condition that often presents with other injuries. Chest wall injuries (CWI) with concurrent TBI remain a significant challenge for clinicians as one set of injuries may exacerbate the other [10]. Through respiratory physiology and predisposition to pneumonia, CWI may lead to prolonged cerebral hypoxia resulting in secondary brain injury—worsening severe TBI. SSRF improves outcomes in polytrauma patients exhibiting CWI with TBI. Surgical management of rib fractures has an essential role in select patients with severe TBI. Further research is warranted to improve our understanding of the complex interplay between the physiology of respiratory mechanics and the neurologic system in the trauma population suffering from TBI. • Surgical management of rib fractures has shown favorable prognoses in select cases. • Flail chest with TBI is a serious condition associated with increased mortality. • Operative fixation of rib fractures with concurrent TBI may show improved outcomes. • SSRF may reduce the rate of pneumonia and ventilation days in select cases. [ABSTRACT FROM AUTHOR]

Understanding of pulmonary mechanics is essential to understanding mechanical ventilation. Typically, clinicians are mindful of peak and plateau pressures displayed on the ventilator and lung compliance, which is decreased in lung disease such as idiopathic pulmonary fibrosis (IPF). Decreased lung compliance leads to elevated peak and plateau pressures. We present a patient with IPF undergoing mechanical ventilation after cardiac arrest. Despite low lung compliance, he had normal peak and plateau pressures due to the presence of flail chest and increased chest wall compliance. This case highlights the role chest wall compliance plays in total respiratory system compliance and pulmonary mechanics. [ABSTRACT FROM AUTHOR]

Highlights • Flail chest is the most critical form of blunt thorax trauma. • Stabilization of rib fractures with titanium plaques is a safe and easy method, giving rapid results. • In cases of flail chest, after a few days mechanical ventilation, implementing stabilization can provide rapid healing. Abstract Introduction Multiple rib fractures exposes serious respiratory disorders and they are generally treated with non surgical methods. Nevertheless, in cases of long term pain despite medical treatment, parenchymal injury, hematoma, posture disorder and flail chest, surgery is needed. Flail chest, as the most critical form of blunt chest trauma, can disturb the hemodynamic of patient significantly and threaten life. This work has been reported in line with the SCARE criteria. Presentation of case A 32 year old male patient referred to our hospital with flail chest in intubated status due to industrial accident. In physical examination, there was displaced dissociation in lower 1/3 of sternum and pericardium was palpated in the subcutaneus tissue. In thorax CT, there was fracture both in the right 7-8. costochondral and in the left 8. costochondral joints. Additionally, crepitation was palpated in these joints. There was flail chest in the right anterior hemithorax and in the lower sternum. Patient was treated with chest wall reconstruction with titanium plaques. Discussion In cases of flail chest, after a few days mechanical ventilation, implementing stabilization provides a rapid healing. Conclusions We believe there is significant place of surgery for stabilization in proper cases. [ABSTRACT FROM AUTHOR]

Introduction Flail chest following blunt trauma chest generally leads to severe pulmonary complications. Thoracic epidural analgesia by means of reducing the pain and consequent splinting may prove beneficial in improving the patient outcome in mechanically ventilated ICU patients. Methods Twenty patients, 18–55 years of age having ⩾3 rib fractures with flail segment, and required mechanical ventilation in the year 2012–14 were included. Patients were randomly divided into groups of 10 patients each to receive either thoracic epidural analgesia with 4 mL of 0.125% bupivacaine bolus followed by infusion @ 4 mL/h with 2 μg/mL fentanyl as adjuvant (Group E) or parenteral analgesia in the form of i.v fentanyl in a dose of 2 μg/kg (group P). Duration of mechanical ventilation, change in tidal volume during initial 24 h, pneumonia, ARDS, length of ICU stay, mortality along with complication were recorded. Results Duration of mechanical ventilation was significantly less in Group E than in group P (6 ± 2 days v/s 9 ± 3 days, p = 0.02). There was significant increase of tidal volume in 1st 24 h in group E (ΔTV: 156 ± 24 mL v/s 78 ± 13 mL in group E & P; p < 0.001). Incidence of pneumonia was 20% and 40% ( p = 0.63) while ARDS was 20% and 35% ( p = 0.35), in Group E and P respectively. Mortality was not different; however, length of ICU stay was significantly less in group E (9.5 ± 1.6 d v/s 12.8 ± 2.8 d, p = 0.004). No serious adverse effects were observed in any of the groups. Conclusion Epidural analgesia significantly decreased the length of ICU stay and duration of mechanical ventilation in our study population. [ABSTRACT FROM AUTHOR]

The article discusses the medical imaging diagnostics for identifying the anatomy of human chest, heart and upper airways and diagnose the types of traumatic pathology and injuries of the human chest. Topics discussed include the benefits of radiography, computed tomography and ultrasonography in chest modality, the technological innovation in medical chest imaging and the importance of medical chest imaging in identifying the treatments for chest inquiries.

Blunt chest trauma is associated with a wide range of injuries, many of which are life threatening. This article is a case study demonstrating a variety of traumatic chest injuries, including pathophysiology, diagnosis, and treatment. Literature on the diagnosis and treatment was reviewed, including both theoretical and research literature, from a variety of disciplines. The role of the advance practice nurse in trauma is also discussed as it relates to assessment, diagnosis, and treatment of patients with traumatic chest injuries. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this study was to determine the impact of surgical rib fixation (SRF) in a treatment protocol for severe blunt chest trauma. Materials and methods: Patients with flail chest admitted between September 2009 and June 2010 to our level I trauma center who failed traditional management and underwent SRF were matched with an historical group. Outcome variables evaluated include age, injury severity score, intensive care unit length of stay (LOS), hospital LOS, ventilator days, total number of rib fractures, and total number of segmental rib fractures. Results: The 2 groups were similar in age, injury severity score, intensive care unit LOS, hospital LOS, total number of rib fractures, and total segmental rib fractures. The operative group demonstrated a significant reduction in total ventilator days as compared with the nonsurgical group (4.5 [0-30] vs 16.0 [4-40]; P = .040). Patients with SRF were permanently liberated from the ventilator within a median of 1.5 days (0-8 days). Conclusions: Surgical rib fixation resulted in a significant decrease in ventilator days and may represent a novel approach to decreasing morbidity in flail chest patients when used as a rescue therapy in patients with declining pulmonary status. Larger studies are required to further identify these benefits [ABSTRACT FROM AUTHOR]

Chest injuries in contact and collision sports are relatively rare, particularly those that are life threatening. However, as with every sports related injury, one must initially consider life threatening situations that may occur as a result of collision with another player, a stationary object, or being struck with some type of object (missile). In other words, as is the case in all acute sports injury assessment, the mechanism of injury must be considered when evaluating the injured athlete on the field as well as on the sidelines. The Sports Physical Therapist (PT) must look for several initial life threatening conditions as well as be aware of and monitor for the development of these symptoms during the subsequent evaluation of the athlete. The purpose of this clinical commentary is to review the presentation and management of several emergent conditions associated with injuries to the chest and thorax. [ABSTRACT FROM AUTHOR]

Flail chest injury occurs from severe impact on the chest cage causing fractures of more than 3 consecutive ribs resulting in instability of that portion of the chest wall. Flail chest injury remains a leading cause of morbidity and mortality. Chronic pain and disability remain long-term complications of this injury. Standard treatment has been internal chest wall support with mechanical ventilation, aggressive pulmonary toilet, and pain management. Recent studies have shown operative stabilization in selected patients with flail chest to have advantages over nonoperative stabilization. These studies have shown a decrease in ventilator days, length of stay, and decreased pain. [ABSTRACT FROM AUTHOR]

Copyright of Collegium Antropologicum is the property of Croatian Anthropological Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Flail chest is most often accompanied by a significant underlying pulmonary parenchymal injury and can be a life-threatening thoracic injury. Its management is often complicated by the other injuries it is frequently associated with. Similarly, mortality and morbidity are dictated most often by the associated injuries and findings. Its treatment is complex and should first be one of pain management, judicious fluid resuscitation, and excellent pulmonary toilet. In those patients requiring mechanical ventilatory support, or who require ipsilateral thoracocotomy, rib stabilization may be considered depending on a host of potentially conflicting indications and contraindications. At the end of this section are listed the current major recommendations and their levels of evidence. [Copyright &y& Elsevier]

Copyright of EMC-Chirurgie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Deadly Dozen ... Lethal Six ... Hidden Six ... Major thoracic injuries are known as the Deadly Dozen. The Lethal Six (airway obstruction, tension pneumothorax, cardiac tamponade, open pneumothorax, massive hemothorax, and flail chest) are immediate, life-threatening injuries that require evaluation and treatment during primary survey. The Hidden Six (thoracic aortic disruption, tracheobronchial disniption, myocardial contusion, traumatic diaphragmatic tear, esophageal disruption, and pulmonary contusion) are potentially life-threatening injuries that should be detected during secondary survey. Each of these may present as immediately life-threatening or potentially life-threatening events. This article provides an overview of these 12 injuries and appropriate man-agement for each. Case studies are included. [ABSTRACT FROM AUTHOR]

A review on the role of open reduction and internal fixation of flail chest injuries is presented. A 37-year-old woman involved in a motorcycle crash sustained comminuted rib fractures on her right 3rd through 12th ribs. On postinjury day 2, the patient's fifth through ninth ribs were surgically reduced and plated. Later that same day, the patient was successfully weaned from mechanical ventilation and experienced a rapid improvement in incentive spirometry volumes. Further studies are needed to definitively determine the benefits of rib plating versus conventional treatment. Through our case, we are able to demonstrate successful management of pain and chest wall instability associated with flail chest through the use of rib plating. [ABSTRACT FROM AUTHOR]

• Surgical fixation of flail chest is indicated in very selected patients. • Several different materials and techniques are available for surgical fixation. • A traditional technique involving Judet and Sanchez-Loret plates is little used now. • Judet and Sanchez-Loret plates can be still useful in cases of thin and fragile bone. Flail chest is now usually treated by conservative methods and surgical fixation remains indicated in selected cases. Different techniques can be used for fixation. The aim of this paper is to present a case in which Judet and Sanchez-Loret plates were employed and to discuss the usefulness of this traditional technique. A 79-year-old woman was admitted for left thoracic trauma with severe antero-lateral flail chest. She was affected by COPD with chronic respiratory failure, ischemic heart disease, autoimmune thrombocytopenia treated on chronic steroid therapy and severe osteoporosis. CT-scan detected multiple rib fractures, left hemothorax and lung contusions. An initial conservative treatment of flail chest involved compressive bandage and then internal pneumatic stabilization in ICU, but it failed. The patient underwent successful surgical treatment of the flail chest by fixation of the anterior fractures from the second to the eight rib. Judet and Sanchez-Lloret plates were used. A bilateral pneumonia developed during the rehabilitation period and the patient died two months after operation. Judet and Sanchez-Lloret plates represent a traditional technique for fixation of flail chest. This technique is less and less used and progressively replaced by newer materials, especially titanium plates with screws or intramedullary struts. Our patient had multiple comorbidities and a very fragile bones that advised against use of screws or intramedullary struts. Judet and Sanchez-Lloret plates can be still considered a useful tool for the fixation of flail chest in cases of thin and fragile bones. [ABSTRACT FROM AUTHOR]

Abstract: Thoracic trauma accounts for 25% of all trauma fatalities in the UK. Blunt injury to the chest can affect any component of the chest wall and thoracic cavity. Mortality is high because of associated multi-system injuries. The most common cause is high-speed road traffic accidents, which result in deceleration injury and compression forces. This contribution discusses the initial management, investigations and definitive management of blunt injuries to the chest. [Copyright &y& Elsevier]

Abstract: Blunt chest injuries are the most common form of thoracic trauma. Pulmonary and myocardial contusions are almost universal to some degree in major chest trauma and are usually managed non-surgically as are injuries to the chest wall. Pneumothorax and haemothorax require pleural drainage, and only rarely need an open thoracotomy for repair of the underlying injury. The majority of patients suffering from a significant major vessel, major airway and cardiac injury will die immediately. In those surviving to hospital their underlying condition may not be easy to diagnose, but prompt recognition and surgical treatment can be lifesaving. Awareness of the spectrum of important injuries and careful inspection of the initial chest radiograph supplemented by CT scanning allows most problems to be investigated appropriately and eventually diagnosed with confidence. Alterations to the usual ATLS management pathway may be necessary to ensure that the interventions normally used to resuscitate patients do not make their condition worse, e.g. endotracheal intubation for major airway trauma, excessive volume transfusion for cardiac tamponade. Patients suffering from blunt chest trauma usually have associated injuries in other parts of the body, especially with the abdomen so in those patients going to theatre for a thoracotomy, a laporotomy also should be seriously considered as an additional procedure. [Copyright &y& Elsevier]

Summary: An unusual case of flail chest is presented. A 55year-old man with no history of trauma presented with back pain and breathlessness. He was found to have a mobile anterior chest wall, gross osteopaenia, a raised ESR and anaemia, but normal Bence–Jones protein. Bone marrow examination and serum electrophoresis confirmed a diagnosis of multiple myeloma. The flail chest was managed with analgesia and rest and the man was discharged home walking unassisted. [Copyright &y& Elsevier]