Blunt chest trauma accounts for a significant proportion of debilitating and life-threatening injuries. Rib fractures are notoriously painful and can lead to prolonged hospitalization, contribute to the development of pneumonia and respiratory failure, and delay outpatient recuperation significantly. Flail chest, along with chest wall deformity, the most severe of chest wall injuries, is associated with significant acute morbidity and mortality. Pulmonary contusion often accompanies blunt chest wall trauma and when diffuse will result in respiratory failure regardless of other injuries. Pulmonary lacerations, pneumatoceles, and even lobar infarction can occur. In this review, we describe the development of current principles of management of rib fractures, flail chest, and pulmonary contusion. Emerging or unclarified strategies include the importance of acute pain control of rib fractures to alleviate the development of chronic pain, the role of rib fracture operative reduction/internal fixation (ORIF) in severe chest wall trauma, and the use of surfactant and dual lung ventilation for severe pulmonary contusion.

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