Factors Influencing Survival After Flail Chest Injuries

M ANY PAPERS devoted to treatment of flail chest leave the impression that this injury can be successfully managed in most cases by simple measures to fix the unstable segment of chest wall. On the other hand, a few authors^1-5 have offered suggestions for management based on the physiological derangements which have been created by this grave injury. These offer a rational basis for treatment. A review of our own recent experience in the treatment of 74 patients with flail chest has shown that only a few patients with small unstable segments of lateral or posterior chest wall can be treated successfully by simple techniques such as inter-costal nerve blocks⁶ to relieve pain and facilitate effective cough. However, the great majority of patients with flail chest injuries require early, vigorous and often prolonged treatment by tracheotomy and controlled intermittent positive pressure ventilation.⁵ This is the absolute minimum