Flail Chest as a Rare Manifestation of Single Rib Fracture: A Case Report.

Abstract

Introduction: Flail chest is defined by the fracture of 3 or more ribs at 2 or more sites, resulting in a segment of the chest wall that loses its mechanical integrity, creating a "floating" segment. It occurs in 5% to 13% of patients with chest wall injuries. A very rare form of flail chest, sternal flail, refers to the separation of the sternum from the hemithoraxes and is usually associated with multiple anterior cartilage or rib fractures. Contrary to common impression, it has more than 1 form and each varies in severity.

Case presentation: A 44-year-old male patient presented to the emergency department with blunt trauma. Imaging studies revealed a third rib fracture with flail chest on the right side, along with multiple rib fractures and a pneumothorax on the left. The lungs showed bilateral contusions. The patient also sustained compression fractures of the third and fifth thoracic vertebrae, a sternal fracture, and a nondisplaced distal radius fracture on the right. The clinical team inserted a chest tube into the left hemithorax to manage the pneumothorax. The patient remained stable and did not require mechanical ventilation. Oxygen therapy was administered via nasal cannula, accompanied by the administration of normal saline and analgesic treatment. Arterial blood gas analysis demonstrated mild lactic acidosis, whereas serial hemogram assessments revealed no clinically significant decline in hemoglobin levels. The patient was subsequently admitted to the department of thoracic surgery for conservative management and close observation, with no immediate indication for surgical intervention. Clinical course remained uneventful, and the patient was discharged on the seventh day in stable condition without complications.

Conclusion: Flail chest may result from a single rib fracture in combination with a sternal fracture. Patients presenting with atypical manifestations of flail chest can be discharged without complications within a short period when early diagnosis, appropriate supportive care, and timely treatment are provided.