Children with rib fractures are managed with supportive care, pain
control, and aggressive pulmonary toilet. Non-steroidal anti-inflammatory
medications, intravenous or oral narcotics, and epidural anesthesia are
effective options for analgesia and should be used judiciously.
D. Flail Chest
Flail chest occurs in less than 1% of pediatric trauma patients. It
manifests when three or more ribs are fractured at more than two points. This
results in an unstable chest wall and is clinically diagnosed as paradoxical
chest wall motion with respiration. Two main factors associated with the
morbidity of flail chest are paradoxical wall motion and underlying pulmonary
contusion.
Management is similar to simple rib fractures and is essentially non-
operative. The primary goal in treating flail chest is supportive respiratory
measures and adequate analgesia. However, in cases of severe respiratory
compromise, such as hypoxia or hypercarbia, intubation and mechanical
ventilatory support may be necessary.
Rib fixation for the treatment of flail chest has been described in the
adult literature with promising results. Open reduction and internal fixation of
flail rib segments stabilizes the chest wall and improves pulmonary mechanics.
Morbidity is consequently reduced because there is an appreciable reduction in
time on the mechanical ventilator, as well as length of stay in the intensive care