Principles of Management

CHEST WALL If a segment of chest wall becomes unstable (e.g. due to multiple rib fractures), particularly when associated with lung contusion, it may be impossible to sustain adequate ventilation (see Chapter 10). Similarly, if the thorax is deformed (e.g. due to kyphoscoliosis), lung expansion will be impaired. These patients may eventually develop ventilatory failure and are prone to recurrent chest infections. On the other hand, ventilatory failure is unusual when chest movement is restricted, but the thorax is uniform (e.g. as in ankylosing spondylitis). Rarely, patients with myopathies or myositis may develop respiratory failure. Mechanical ventilation may be required and can allow time for the diagnosis to be established (e.g. by muscle biopsy).