Correspondence Address:
Moheb A Rashid
Editor in Chief of the Journal of Cardiothoracic Trauma
Sweden

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Clinically, a flail chest (FC) is defined as paradoxical movements of a part of the chest wall following trauma when two or more contiguous ribs are fractured in two or more locations. This definition is classically recited in the literature and by the major textbooks in cardiothoracic and trauma surgery. However, the author of this Editorial has been observing some cases with clinically evident FC after chest trauma contradicting the current radiological definition that sometimes needs three or more contiguous and at least doubled fractured ribs. One of these cases has been documented by the author [Video 1] showing the typical but small FC, together with computed tomography (CT) three-dimensional figure [Figure 1] of the chest wall demonstrating that fractures are not consistent with the classic definition that we have been taught during the years. Here, we have single fractures in ribs 7–10, not in the floating ribs (11–12). We could not see any obvious CT-verified cartilaginous separations in the fractured ribs or any palpable defects medially to the flailed segment. This means that flailing does not always necessitate more than one fracture in the same rib to produce this significant clinical phenomenon. Therefore, the author questions the traditional definition and suggests a new one, i.e., more correct and more comprehensive-based solely on the clinical findings. FC could be defined as the paradoxical movement of a segment of the chest wall with or without ventilation derangements following chest trauma whatever the radiological findings even in case of a single fracture in a single rib.{Figure 1} [SUPPORTING:1]