In a series of 166 patients with nonpenetrating injuries of the chest there were 118 with fractures of ribs. Thirty-one of these were of the stove-in (flail chest) type, accompanied by paradoxical sinking-in of the chest wall during inspiratory contractions of the diaphragm. Sand bags sufficed to correct this dangerous condition in 9 patients, but in 19 it was necessary to apply traction either to the sternum or to the pectoral muscles. Immediate thoracotomy was resorted to on four occasions. Two patients with organized hemothorax and one with empyema required decortication. From this small number of complications it appears that early operation for nonpenetrating chest wounds is seldom indicated. Of eight deaths in this series only two were directly attributable to the injuries within the chest.
Craighead CC, Glass BA. MANAGEMENT OF NONPENETRATING INJURIES OF THE CHEST. JAMA. 1960;172(11):1138-1142. doi:10.1001/jama.1960.03020110022006