This occurs when multiple fractures are sustained with more than one site per rib. The main danger is that the patient may lapse into respiratory failure.

Clinical Features

The features include the following:

  • Chest pain
  • Paradoxical chest movement
  • Dyspnoea may be present
  • Evidence of fractured ribs
  • Haemothorax or pneumothorax or both


  • Chest radiograph


  • Splint the flail segment.
  • Administer analgesia. Make sure no neurological deficit is present.
  • Restrict fluids to avoid development of adult respiratory distress syndrome.
  • Observe for respiratory failure: If it develops, transfer patient to ICU. If no respiratory failure results, continue with conservative management in general wards.
  • At referral centre if referred to ICU: Carry out intubation with positive end expiratory pressure (PEEP) applied.