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Cases of flail chest injury for 24 client-owned companion animals following various traumas were evaluated. Concurrently sustained injuries, initial emergency treatments, and definitive treatment and outcome for regimens that utilize stabilization of the flail segment were compared with cases treated with no stabilization.
Flail chest was confirmed in 24 animals: 21 dogs and three cats. There was an even division (12 each) of right and left flail segments. The median number of ribs involved was three (range, two to seven). Flail segment stabilization was performed in nine, and 15 were treated with no stabilization. Statistical analysis using multiple data permutations evaluating all combinations failed to reveal a significant difference in outcome between stabilized and unstabilized cases.
J Am Anim Hosp Assoc 2002;38:315-320.
Introduction
Flail chest exists when the intrinsic costal arch support of a section of the thoracic wall has been lost due to multiple (a minimum of two) fractures of at least two adjacent ribs. The section is said to "flail" asynchronously with the normal motion of the thorax during respiration. This "flailing" motion is paradoxic with normal thoracic wall movement and is characterized by inward displacement during inspiration and outward displacement during expiration. The clinical signs of difficult and exaggerated breathing that often accompany flail chest were thought for many years to be due, in large part, to the paradoxic movement of the flail segment.1-7 The basis for this assumption was that pendulous airflow between lungs was thought to result from the loss of thoracic wall integrity (Pendelluft theory).1,2,5,6 The theory states that air in the lungs beneath the flail segment would flow across to the lung in the opposite hemithorax during inspiration and then back again during expiration. The abnormal airflow was said to contribute to an increase in the physiological "dead space." When this is combined with decreased vital and functional residual capacities, decreased pulmonary compliance, and increased airway resistance resulting from the flail segment, severe respiratory distress may result. This thinking led to the widespread recommendation that the flail segment be stabilized as soon as possible, and in many instances this perspective still prevails.3,4,8,9 Consequently, there have been many techniques described for stabilization-from procedures that place and maintain traction on the unstable ribs to internal fixation of the...