Should a "Flail Chest" Be Treated Medically or Surgically?

QUESTION: A recent accident brought my husband to the emergency room with a
number of injuries, including one they kept referring too as a "flail chest".
There was considerable discussion among the doctors, which I could not follow,
but they ended up treating this injury "medically" instead of "surgically".
My husband pulled through fine, but I always wondered what the discussion was
all about. Can you figure it out for me?
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ANSWER: In my opinion, the patient can frequently do better when physicians
with different specialty expertise and experience confer about a patient's
condition, and choose the best possible treatment. Let's first explain the
term "flail chest". When a section of the chest wall no longer moves with the
rest of chest, because of multiple fractures of several ribs, their cartilage
attachments, and the central bone of the chest (the sternum), it resembles the
free swinging portion of the tool the flail, that was used to thresh grain by
hand. This section of the chest now moves in during inspiration, and outward
with expiration (the opposite of normal) and reduces the ability of the lung
to fill with air. Breathing becomes labored and difficult, and the body
cannot get the oxygen it needs. For many years, treatment consisted of fixing
this moving chest section by external means. More recently, the use of
equipment to increase the pressure within the lungs during respiration was
successful. However, it is now believed that the treatment of the injured
lung beneath the ribs is most important, and by reducing fluids, the
congestion which also develops in injured lung tissue may also be reduced.
Pain relief and the use of corticosteroids is most useful, and thus flail
chest can be successfully treated medically, rather than by mechanical or
surgical fixation. There are times, however, when the situation demands that
breathing be aided using a respirator, and when surgical intervention to
stabilize the chest wall is a must. Your husband was fortunate that this was
not necessary, and his recovery time was probably reduced.