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Multiple rib fractures: does flail chest matter?
  1. Yaakov Daskal1,
  2. Maya Paran1,
  3. Alexander Korin2,
  4. Vladislav Soukhovolsky3,
  5. Boris Kessel1
  1. 1Surgical Division, Hillel Yaffe Medical Center, Hadera, Israel
  2. 2Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel
  3. 3Forest Institute, Russian Academy of Sciences Siberian Branch, Novosibirsk, Russia
  1. Correspondence to Dr Yaakov Daskal, Surgical Division, Hillel Yaffe Medical Center, Hadera 3845813, Israel; kobidaskal{at}gmail.com

Abstract

Background Recent studies have reported significant morbidity and mortality in patients with multiple rib fractures, even without flail chest. The aim of this study was to compare the clinical outcome and incidence of associated chest injuries between patients with and without flail chest, with three or more rib fractures.

Methods This study included patients with blunt trauma with at least three rib fractures, hospitalised during 2010–2019 in the Hillel Yaffe Medical Center in central Israel (level II trauma centre). Patients with and without radiologically defined flail chest were compared with regard to demographics, Injury Severity Score (ISS), GCS, systolic blood pressure (SBP) on admission, radiological evidence of flail chest, associated chest injuries, length of stay in intensive care unit, length of hospitalisation and mortality.

Results The study included 407 patients, of which 79 (19.4%) had flail chest. Overall, pneumothorax and haemothorax were more common among patients with flail chest (p<0.05). When comparing patients with three to five rib fractures, there was no difference in length of intensive care and length of hospitalisation or mortality; however, there was a higher incidence of pneumothorax (24.6% vs 50.0%, p<0.05). When comparing patients with six or more rib fractures, no difference was found between patients with and without flail chest.

Conclusion In patients with three to five rib fractures, pneumothorax is more common among patients with flail chest. Clinical significance of flail chest in patients with more than six rib fractures is questionable and flail chest may not be a reliable marker for severity of chest injury in patients with more than six fractures.

  • trauma
  • chest
  • fractures and dislocations
  • pneumothorax

Data availability statement

Data are available upon reasonable request from the author (kobidaskal@gmail.com).

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Data availability statement

Data are available upon reasonable request from the author (kobidaskal@gmail.com).

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Footnotes

  • Handling editor Jason E Smith

  • Contributors All authors have made substantial contributions to all of the following: the conception and design of the study, or acquisition of data, or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content and final approval of the version to be submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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