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Two hundred and fifty patients with chest trauma admitted consecutively over a 6-year period to the Royal Surrey County Hospital were reviewed. This is a large series by British standards. The cause and nature of their chest and associated injuries were studied, together with the management, complications and outcome. The aim of this study was to find areas where diagnosis and treatment could be improved. It was found that where there was no lung contusion, flail chest injuries could be managed without ventilation. The review suggests that even small traumatically induced pneumothoraces should be drained. It illustrates the need for an awareness of the wide range of concurrent problems in patients with chest injuries and the variety of possible complications.