On his website (where you can read this story), Bacigalupi notes that this was his first published story after a failed period of trying to write novels; and in some ways, it seems to return to the themes and form of his previous story, "Pocketful of Dharma" (covered here).
Like that story, this is the story of a poor, crippled, exploited person and the pitiful stand they take against the system that's using them. In that story, Jun is a poor country boy whose back is hunched from disease or malnutrition; who gets caught up in a search for a datacube between powers that are far beyond him and whose struggle he doesn't even understand; and whose rebellion takes the form of climbing down a giant tower, not knowing if he'll even survive the climb, let alone if he'll survive life on the hard streets below.
Here, the main character Lidia is one of a pair of twins who have been bought by the media super-star Madame Belari, who has shaped the twins through a series of grotesque surgeries into perpetual children whose bodies are also musical instruments. (The performance they put on is a mix of decadent pornography--twins! underage girls!--and music.) So here we see a slight change between the stories: Jun's crippling was incidental, Lidia's (and Nia's) was intentional.
Like Jun, Lidia doesn't really understand the wider world, though she has an information source--a fellow slave who tells her all about how there are places out on the coast where people control their own lives, not these "fiefdoms" where rich people consume the lives of others. This definitely helps to give Lidia's story some explicit depth (though you've got to wonder where fellow slave Stephen got all this info).
"Fluted Girls" also has another axis here, in that Madame Belari may be a rich star, but she's also at the whim of certain market forces. In fact, her desire to make profitable freaks of Lidia and Nia is motivated by a desire to stay free from TouchSense. The irony here is thick, almost too like an anvil: Belari consumes others in order not to be consumed herself (like Ed Harris in The Truman Show, whose desire for privacy was bound up with his total surveillance of Truman).
It's a rich, political story, and I mostly like it, though there were times where the description seemed to repeat itself to no purpose--except maybe to delay te reader and heighten anticipation? Maybe, but it wasn't always successful. The other slight misstep I felt here was the open ending: it's a nice mirroring of the opening--Lidia holds the poison in her hand, weighing the possibilities of it. But her sudden realization that she could feed the poison to Belari was just that--too sudden.
I may be in the minority there, though, since this was republished in both Gardner Dozois's The Year's Best Science Fiction: Twenty-First Annual Collection and Ellen Datlow's The Year's Best Fantasy & Horror: Seventeenth Annual Collection.