Chest Wall Trauma: Mechanisms, Classification and Management

Thoracic trauma is responsible for morbidity and mortality in a significant percentage of multiply injured patients. While lung parenchymal and vascular injuries are often the focus of initial trauma management, chest wall injuries are associated with high morbidity and mortality that ranges even to 20%, depending on age, pre-existing pulmonary disease, higher number of rib fractures and flail chest.

Depending on the mechanisms involved in chest wall injuries, we may suspect solid organ contusions, fractures, overpressure injuries, tearing injuries and barotrauma. Accurate identification and description thrpugh imaging techniques are essential for their management, with computed tomography being the most sensitive test.

Adequate pain control with epidural catheters and intercostal nerve block as well as oxygenation are a mainstay of conservative management. In the context of flail chest, surgical stabilization has been associated with fewer days of mechanical ventilation, decreased rates of chest infection, improved long term respiratory function and less chronic pain. The degree of severity of the injury, the injury mechanisms, and the adequacy of unassisted ventilation will guide the need for surgical management or not.