Flail chest injury in a patient with surgical absence of the sternum

Although pulmonary disability is usually minimal following total sternectomy, the potential for remote complications exists. We present a case of severe respiratory failure resulting from simple rib fractures occurring two years after sternectomy for sternal osteomyelitis. Respiratory failure resulted from flail chest due to the combination of acute rib fracture and the lack of anterior fixation of the thoracic cage.