Management of Chest Wall Injuries: An Updated Review

Injuries to the chest wall are common after blunt thoracic trauma, which can cause injury to the ribcage and intrathoracic structures. Such trauma can result in a spectrum of injuries, ranging from minor injuries such as an isolated rib fracture to extensive injuries such as multiple rib fractures/flail segments with underlying lung or intrathoracic injury. The primary focus of this article will be on the assessment and treatment of injuries of the bony chest wall, with an emphasis on flail chest and multiple rib fractures. Patient evaluation, treatment, and outcomes differ depending on the severity of injury. The use of CT scans has become routine in the diagnosis and evaluation of injury severity. Treatment options include both nonsurgical care (analgesia, regional anesthetic techniques, and mechanical ventilation) and surgical fixation of the chest wall. While there has been notable interest in surgical fixation of flail chest injuries over the past two decades, there remains controversy regarding the potential benefits of surgery and the indications for surgical management. However, it is clear that patients with flail chest injuries are best managed by a multidisciplinary team, including collaboration between orthopaedic and trauma surgery.