Flail chest is usually accompanied by a pulmonary contusion, a bruise of the lung tissue that can interfere with blood oxygenation.

The concern about "mediastinal flutter" (the shift of the mediastinum with paradoxical diaphragm movement) does not appear to be merited.

[9] The respiratory failure from the flail chest requires mechanical ventilation and a longer stay in an intensive care unit.

Flail chest can also occur when ribs are fractured proximally in conjunction with disarticulation of costal cartilages distally.

For the condition to occur, generally there must be a significant force applied over a large surface of the thorax to create the multiple anterior and posterior rib fractures.

In children, the majority of flail chest injuries result from common blunt force traumas or metabolic bone diseases, including a group of genetic disorders known as osteogenesis imperfecta.

Treatment of the flail chest initially follows the principles of advanced trauma life support.

Usually one side of the chest is affected more than the other, so each lung may require drastically different pressures and flows to adequately ventilate.

Surgical fixation can help in significantly reducing the duration of ventilatory support and in conserving the pulmonary function.

[16] In order to begin a rehabilitation program for a flail chest it is important to treat the person's pain so they are able to perform the proper exercises.

Due to the underlying conditions that the flail segment has caused onto the respiratory system, chest physiotherapy is important to reduce further complications.

[1] A systematic review comparing the safety and effectiveness of surgical fixation versus non-surgical methods for the treatment of flail chest, reported that there was no statistically significant difference in the reported deaths between patients treated surgically and those treated non-surgically i.e. with conservative management methods.