The thorax consists of the sternum, 12 pairs of ribs, and 12 thoracic vertebrae interconnected together. Rib fractures are the most common among thoracic fractures, about 90%. The 4th to 7th ribs are long and thin and are most likely to break. The thorax is a kind of chest trauma in which three or more adjacent ribs are fractured in two or more places to form a floating chest wall. The combination of shackle chest with paradoxical breathing can lead to severe hypoxemia and mediastinal oscillation, endangering the patient’s life. Most of the cases of shackle chest are caused by multiple rib fractures, which tend to cause paradoxical movement of chest wall, often accompanied by pulmonary contusions and, in severe cases, respiratory and circulatory failure, therefore, paradoxical respiratory movement should be eliminated as soon as possible, airway patency and adequate oxygen supply should be maintained, respiratory and circulatory dysfunction should be corrected and shock should be prevented. Causes of rib fracture caused by shackle chest: The shackle chest caused by rib fracture is mostly caused by external violence. When direct violence acts on the chest wall, rib fractures often occur locally in the struck area, with the fracture end to the interior of the thoracic cavity, which can lead to damage to the internal organs of the thoracic cavity. When indirect violence acts on the chest wall, the chest wall is squeezed and rib fractures occur at sites other than the point of violence, with the fracture ends to the outside of the chest wall, which can easily cause soft tissue damage to the chest wall and local bleeding and swelling of the injured blood vessels. In addition osteoporosis, bone softening, and bone destruction caused by primary or metastatic rib tumors can result in pathological fractures. Clinically, rib fractures are mostly caused by direct violence.