Flail chest: Conservative management

Chest wall trauma is a component of injury in 75% of trauma death,with elderly and high risk patients being the most vulnerable.(Luchette and coworkers 1994).The majority of these trauma involves pulmonary contusions and cardiovascular injuries.Ziegler et all (1994) report a 12% of mortality on 711 patients affected by rib fractures a flail chest was evident in 3% of themC.A flail chest is defined as three or more sequential ribs with fracture in at least two location,resulting in a segment that moves indepentently of the remaining ribs during spontaneous respirations.The therapeutical approach to this condition largely depend from the lung conditions.In these report we trie to summarize the element that caracterize the conservative management of flail chest without to express a personal opinion in the choice between surgical and conservative approach. We don't find in literature clear guidelines about this topic.The impression we have on revising the literature is that surgical and conservative therapies can find the right role in accordance with the patient's conditions.The most discussed point seems to be analgesia strategy and ventilatory pattern.