Cardiopulmonary Resuscitation-Induced Hardware Failure After Surgical Stabilization of Flail Chest

Flail chest occurs when three or more ribs have concurrent fractures in two or more places. Flail chest is a marker of injury severity and is associated with increased morbidity and mortality. The management of flail chest includes multiple nonoperative components in addition to surgical stabilization, which has been shown to lower mortality rates to those of multiple rib fractures with a stable chest wall (i.e., no flail chest). The resulting stability of the chest wall may be a more accurate prognostic indicator than the actual number of ribs fractured. Surgical stabilization has been associated with various complications. The overall incidence of hardware failure is relatively rare and often involves the anterolateral and lateral regions of the chest wall. We present a unique case of a 48-year-old male involved in a motor vehicle accident with multiple traumatic injuries, including flail chest. He ultimately underwent surgical stabilization across six separate ribs in nine total locations. The patient's condition deteriorated several weeks later, and he required cardiopulmonary resuscitation. High impact forces caused hardware failure in three separate locations along the chest wall, i.e., anteriorly, anterolaterally, and posterolaterally. The most significant failure occurred anteriorly with sternal plate and screw separation. We suspect that hardware failure in the anterior and anterolateral regions indicates that the sternum and costochondral junction may be dynamic areas of the chest wall that dissipate forces differently than do the bone of ribs.