Pain control. Flail chest is generally treated with pain control to allow the patient to cough, deep breathe and clear any secretions. Pain control can be obtained with IV narcotics, oral narcotics, subcutaneous pain pumps or an epidural catheter. Recently, there has been increased interest in fixing the ribs with plates. The jury is still out on this but is appropriate in the right patient.
Pain control plus... Pain control is key...Depending on the level of associated lung injury, breathing support may be needed--noninvasive positive pressure ventilation (cpap or bipap mask) or intubation/mechanical ventilation. Surgery to stabilize the chest wall may be indicated, but this is controversial.
Surgery . Flail chest is usually best treated by surgery. I have a video online of this surgery - look on youtube for flail chest and drbentaylor.
See below. Flail chest, multiple ribs fractured in multiple places on one side of the chest, can cause inability of the lung to expand on that side. Usually ventilator support and underlying lung healing will allow the ribs to heal on their own. Rarely surgery is needed to fixate the ribs if there is too much damage or lack of self-healing. Chest wound is treated with cleaning, suturing only if appropriate. Read more...