Sharp rib fragment threatening to lacerate the aorta in a patient with flail chest.

A 50-year-old man who was the victim of an accident during work was taken to the hospital. His chest radiograph and computed tomography (CT) scan showed pulmonary contusion, multiple rib fractures (left 5th to 1lth ribs), hemopneumothorax, and splenic rupture. On the fourth posttrauma day, CT showed bone particles of the ninth rib migrating to the thoracic aorta. These bone particles were threatening to penetrate the thoracic aorta. He underwent operation to repair the flail chest by approximating the left ribs and partial lung resection. After the operation the flail chest improved, enabling extubation the first day after the operation. He was mobile and was discharged on the 17th postoperative day. A literature review revealed cases of sudden death when such rib fragments lacerated the aorta. We therefore propose an early operation for patients who have multiple bone fractures in the left chest.