Traumatic Rib Fractures Complicated by Extensive Subcutaneous Emphysema: Is the Macklin Effect the Culprit?

Subcutaneous emphysema is a recognised complication of blunt thoracic trauma and most commonly occurs at the time of injury due to disruption of the pleura or alveoli from rib fractures.This case highlights that delayed progression remains uncommon and unpredictable.A 47-year-old man presented following a fall, sustaining multiple right-sided rib fractures, and was initially clinically stable.Approximately 72 hours after admission, the patient developed sudden and rapidly progressive subcutaneous emphysema with facial, chest, abdominal, and scrotal swelling, dysphonia, and increasing oxygen requirements.CT imaging at the time revealed the development of extensive subcutaneous emphysema, pneumomediastinum, and new bilateral pneumothoraces.The patient was managed with bilateral chest drain insertion, and over the following days, clinical stabilisation and gradual radiological improvement were achieved.Our findings highlight the potential for delayed and sudden deterioration following blunt chest trauma and the potential limitations of early clinical stability in predicting disease progression.