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Rehabilitation of Flail Chest

History of Flail Chest

Approximately 5% - 13% of patients with chest wall injuries in the United States sustain a flail segment of the ribcage. Flail chest is one of the most serious injuries caused to the chest by blunt force trauma. It is also a very rare injury. Flail chest is described as a detached section of the ribcage from the wall of the chest. Usually this occurs when there are multiple fractures or breaks along a single rib, and that piece that has broken off from each side has the ability to move independently from the rest of the rib cage. Therefore, the independent segment, due to negative pressure inside the thoracic cavity, is stretched inward during inhalation and due to positive pressure is stretched outward during exhalation. Improper breathing and inability to take deep breathes are usually associated with flail chest due to the deformity caused by the injury, and from the pain that is developed. The injury disrupts gas exchange due to the reduction of oxygen entering the lungs which may lead to hypoxemia, hypercapnia, and respiratory acidosis. Other lung conditions associated with flail chest are atelectasis, which leads to alveolar hypoventilation and improper transport of mucous. Therefore, flail chest is very important to treat because it may lead to respiratory failure and death. Furthermore, rehabilitation for patients with flail chest is vital for the reduction of long term deformity, pulmonary complications, and mortality.

Physiotherapy of Flail Chest

In order to begin a rehab program for a recovery patient with flail chest it is important to treat the patient for pain so the patient is able to perform the proper exercises for recovery. Due the underlying conditions that the flail segment has caused onto the respiratory system, chest physiotherapy is important to reduce further complications. Proper positioning of the body is key, including postural alignment for proper drainage of mucous secretions. The therapy will consist of a variety of postural positioning and changes in order to increase normal breathing. Along with postural repositioning, a variety of breathing exercises are also very important in order to allow the chest wall to reposition itself back to normal conditions. Breathing exercises will also include coughing procedures. Furthermore, range of motion exercises are given to reduce the atrophy of the musculature. With progression, resistance exercises are added to the regimen to the shoulder and arm of the side containing the injury. Moreover, trunk exercises will be introduced while sitting and will progress to during standing. Eventually, the patient will be progressed to walking and posture correction while walking. Before, the patient is discharged from the hospital the patient should be able to perform mobility exercises to the core and should have attained good posture.

Rehabilitation of Flail Chest

After discharge the patient should enter a 12 week outpatient program for at least 3 days a week The patient should be seen for 30-45 minutes a day after a 5-10 minute warm up session. After the patient is discharged from outpatient therapy the patient should be given an exercise regimen to be performed at home. In conclusion, it is detrimental for a patient’s health after receiving a flail chest injury to be seen by a physiotherapist, with pain management, for proper recovery to be discharged from the hospital and should be placed in an outpatient physical therapy program for rehabilitation in order to regain the strength and endurance necessary for everyday life functioning.

Thoracic expansion exercise- allows the chest wall to expand and increase volume in the lungs.

Inspirometer. Inspiratory muscle training- used in rehabilitation of the lung functioning. Helps increase the endurance and strength of muscles used for inspiration.