The incidence of chest trauma varies from 12-25% depending on whether the series have predominant blunt trauma or penetrating trauma. Thoracic trauma may be as a result of vehicle accident, crush injury, stab wounds, gunshot wounds or fall from hills or industrial accident, and blast injury following bomb explosions. Injuries may be immediately life threatening or potentially life threatening. Chest injuries occur by three principal mechanisms. These are body acceleration and deceleration, body compression, high speed impact. Chest injury may be classified according to anatomical location and by the injuring agent. Conditions which are influenced by pre hospital care are: compromised airway, potential fracture of the cervical and thoracic spine, flail chest, pulmonary contusion, sucking chest wound, tension pneumothorax, and pericardial tamponade. Respiratory distress may be due to: sucking (open) chest wound, tension pneumothorax, flail chest, pulmonary contusion, haemothorax. Circulatory collapse/instability may be due to: massive haemothorax and cardiac tamponade. Diagnosis is by clinical examination and is often supplemented by X-ray chest. In stable patients CT scan may be required to rule out cause of respiratory distress if X-ray chest is noncontributory. Tube thoracostomy is the only invasive procedure that 85% of patients with chest trauma may require. Indications for thoracotomy may be acute or non-acute. The incisions used for a patient requiring operation for a chest injury is dictated by the diagnosis and anticipated injuries.