A 50-year-old man falls from height and presents with severe chest pain and paradoxical movement of a segment of the right anterior chest wall. He is tachypnoeic with SpO2 89% on room air and significant chest wall contusion. The most appropriate initial management is:

• A Strapping or binding of the affected chest wall segment
• B Intercostal drain insertion through the flail segment
• C Immediate operative fixation of the fractured ribs
• D Analgesia, oxygen therapy and positive pressure ventilation if respiratory failure develops ✓

Explanation

Flail chest occurs when two or more adjacent ribs are fractured in two or more places, producing a free-floating segment that moves paradoxically. The main problem is the underlying pulmonary contusion, so management is aggressive analgesia, oxygen, physiotherapy, and mechanical ventilation for respiratory failure or shock. Strapping restricts chest excursion and worsens ventilation, an outdated practice.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.