Flail chest occurs when 2 or more ribs are fractured in 2 or more locations 1 and can lead to chest wall instability and loss of thoracic volume,decreased lung volume, atelectasis, chest tightness, dyspnea, and chronic pain. 2 On physical examination, crepitus, subcutaneous emphysema, and asymmetrical chest wall expansion are common findings. Ribs 6 to 8 on the left were repaired with open reduction, internal fixation.