Which injury results when two or more adjacent ribs are fractured in two or more places, creating a segment of chest wall that moves paradoxically?

• A. Rib injury
• B. Flail segment
• C. Traumatic asphyxia
• D. Sucking chest wound

Answer: (B)

Paradoxical chest wall movement from multiple rib fractures is called a flail segment. The defining feature is two or more adjacent ribs broken in two or more places, creating a segment of the chest wall that becomes detached from the rest of the thorax. During inspiration, this free-floating segment moves inward while the rest of the chest expands, and during expiration it moves outward when the chest should be falling inward—hence the paradoxical movement.

This pattern tells you that the chest wall’s stability is compromised, which can severely impair ventilation and often accompanies pulmonary contusion or other chest injuries. In first aid and prehospital care, the focus is to support breathing and oxygenation, provide assisted ventilation if needed, and stabilize the patient while preparing for definitive care.

Other options don’t fit because they describe different injuries: traumatic asphyxia results from chest compression causing facial edema and hemorrhage, not paradoxical chest movement; a sucking chest wound is an open pneumothorax with air entering through a chest wall wound; a rib injury is too general and doesn’t specify the dangerous, paradoxical segment.