The Bottom Line: Initial management primarily focuses on maintaining adequate ventilation. Presently, most patients are admitted to a trauma ICU and receive aggressive pulmonary toilet and pain control. For patients with isolated flail chest injury, adequate analgesia greatly facilitates pulmonary toilet and early patient mobilization. Early intubation and mechanical ventilation is paramount for patients with refractory respiratory failure. Systemic opioids may provide adequate pain relief. Patient controlled anesthesia is also effective. Patient controlled anesthesia with a continuous infusion has been shown to improve pain scores; however, respiratory depression may result.
Pettiford, Brian The management of flail chest. Thoracic surgery clinics 2007 vol:17 iss:1 pg:25 -33
the definition of Flail chest is the fracture of four or more consecutive ribs in at least two places. It is accompanied by paradoxical motion of the affected chest wall segment during respiration such that the flail segment collapses during inspiration and expands during expiration. Flail chest can be subdivided into anterior and posterior flail chest depending on the presence of fractures along the anterior or posterior rib angles.