Simultaneous Surgical Treatment of Sternum and Costal Cartilage Fractures

doi:10.1016/j.athoracsur.2018.06.044

The Annals of Thoracic Surgery

Volume 107, Issue 2, February 2019, Pages e119-e120

https://doi.org/10.1016/j.athoracsur.2018.06.044 Get rights and content

Studies have confirmed that, for severe flail chest or sternal fractures and even multiple rib fractures, surgical treatment can effectively reduce hospital stay and relieve chest wall pain. However, fixation of multiple costal cartilage fractures in such a small area is a challenge if an internal fixator is simply placed directly on the sternum. This case report shares a method of simultaneous fixation of multiple costal cartilage and sternal fractures through a small incision, and it is also appropriate for multiple costal cartilage fractures without sternal fracture.

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The study confirms that whether it is a severe flail chest, a sternum fracture, or even multiple rib fractures, surgical treatment can effectively reduce the hospital stay and the duration of intensive care unit stay 1, 2. In addition, the curative effect in a patient with pulmonary infection and thoracic deformity is obvious. In our case, the patient had a severe floating chest wall deformity and was not able to be weaned from the ventilator before the operation. At that time, he was unable to

References (3)

S. Schulz-Drost et al.
The operative management of flail chest injuries with concomitant sternal fracture
Chirurgia (Bucur)
(2017)

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Cited by (10)

Costal cartilage fracture: A commonly missed thoracic injury in trauma patients
2022, Radiology Case Reports
Citation Excerpt :
The majority of patients are managed conservatively with analgesia [5]. In some cases, patients may undergo surgical plate fixation [9,10]. The natural prognosis of CC fractures is also unknown, particularly whether these fractures will heal to form a stable union or remain a concern for possible instability of the thoracic wall [11].
In this report, we describe a case of a 43-year-old male who sustained a displaced mid chondral costal cartilage fracture along with multiple ipsilateral rib fractures following a jet ski collision. Costal cartilage fractures (CC) are commonly missed on imaging evaluation, and accordingly underreported in the literature. High-energy blunt chest trauma represents the most common mechanism for CC injuries. Computed Tomography (CT) is the modality of choice to diagnose CC fractures along with the associated cardiopulmonary and abdominal injuries in polytrauma patients. There is currently no consensus with respect to the management of CC fractures. Further research is required to explore the long-term impact of CC fractures on thoracic cage stability.
The Chinese consensus for surgical treatment of traumatic rib fractures 2021 (C-STTRF 2021)
2021, Chinese Journal of Traumatology - English Edition
Citation Excerpt :
It is reported that the fractured ends of the costal cartilage near the sternum are fixed to the sternum, but there is a risk of affecting the compliance of thorax, which has not been confirmed yet. In literature, there are some reports on plate and screw fixation for rib fracture combined with sternum fracture,60 or costal cartilage fracture.61 For rib fractures (non-FC), all displaced ribs should be fixed (level ⅡB);
Rib fracture is the most common injury in chest trauma. Most of patients with rib fractures were treated conservatively, but up to 50% of patients, especially those with combined injury such as flail chest, presented chronic pain or chest wall deformities, and more than 30% had long-term disabilities, unable to retain a full-time job. In the past two decades, surgery for rib fractures has achieving good outcomes. However, in clinic, there are still some problems including inconsistency in surgical indications and quality control in medical services. Before the year of 2018, there were 3 guidelines on the management of regional traumatic rib fractures were published at home and abroad, focusing on the guidance of the overall treatment decisions and plans; another clinical guideline about the surgical treatment of rib fractures lacks recent related progress in surgical treatment of rib fractures. The Chinese Society of Traumatology, Chinese Medical Association, and the Chinese College of Trauma Surgeons, Chinese Medical Doctor Association organized experts from cardiothoracic surgery, trauma surgery, acute care surgery, orthopedics and other disciplines to participate together, following the principle of evidence-based medicine and in line with the scientific nature and practicality, formulated the Chinese consensus for surgical treatment of traumatic rib fractures (STTRF 2021). This expert consensus put forward some clear, applicable, and graded recommendations from seven aspects: preoperative imaging evaluation, surgical indications, timing of surgery, surgical methods, rib fracture sites for surgical fixation, internal fixation method and material selection, treatment of combined injuries in rib fractures, in order to provide guidance and reference for surgical treatment of traumatic rib fractures.
Cartilage Plating in Flail Chest Fixation
2021, Injury
Citation Excerpt :
Given the fact that rib fracture patterns often include the anterior thorax, including the sternum and costal cartilage, reduction and instrumentation of this region can be necessary to provide optimal patient outcomes [6,7]. Very limited data is available regarding open reduction and internal fixation (ORIF) of anterior rib fractures involving the costal cartilage, with only several case reports published at this current time [8-10]. As two- and three-dimensional computed tomography has been accepted as the gold standard for identification of rib fractures, the ability to detect anterior cartilage injuries has also increased [11].
Introduction: Operative stabilization of flail chest has been shown to have several benefits over nonoperative management. Often, flail chest injuries will involve the anterior ribs and their associated costal cartilage. In certain cases, operative fixation with open reduction and internal fixation (ORIF) of anterior rib fractures involving the costal cartilage may be warranted. Currently, there is scant literature regarding the surgical approach and clinical outcomes of ORIF involving the costal cartilage. The purpose of this study is to describe the surgical approach and first reported clinical series for patients undergoing anterior rib ORIF involving the costal cartilage.
Patients and Methods: After Institutional Review Board approval was obtained, a retrospective case series was performed at a single urban level 1 trauma center including patients 18 years of age or older who underwent ORIF of anterior rib fractures involving the costal cartilage. All surgical approaches were performed with muscle-sparing techniques. Patients were followed during their hospitalization period and postoperatively as routinely scheduled. Data collection including patient demographics, injury characteristics, operative variables, and postoperative outcomes were collected and analyzed.
Results: Thirty patients, with a mean age of 54.4 years, were included in this study. All patients had a flail chest injury and were treated with ORIF on average 4.1 days following injury. There were no intraoperative complications reported. Total hospital length of stay averaged 22.8 days with an intensive care unit stay averaging 6.1 days; total ventilator time averaged 5.2 days. Six patients were diagnosed with postoperative pneumonia and no postoperative superficial infections, deep infections, or seromas were noted. Eight patients required tracheostomy postoperatively. Only 1 patient had evidence of radiographic malunion, and a separate patient had evidence of screw loosening; no patients required or requested implant removal. Union rate was 100% and one-year mortality was 0%.
Conclusion: Open reduction and internal fixation of anterior rib fractures involving the costal cartilage is a safe procedure with low complication rates and favorable postoperative outcomes including hospital length of stay, intensive care unit length of stay, postoperative pneumonia, need for tracheostomy, and mechanical ventilation time.
Chinese consensus on diagnosis and treatment of traumatic rib and sternal fractures
2023, Chinese Journal of Thoracic and Cardiovascular Surgery
Open Reduction and Internal Fixation of a Chronic Precordial Flail Chest Segment: A Case Report
2023, JBJS Case Connector
Sternal Fractures due to Blunt Chest Trauma
2022, Journal of the College of Physicians and Surgeons Pakistan

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^∗: Drs Gao and Li contributed equally to this work.

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Case reportSimultaneous Surgical Treatment of Sternum and Costal Cartilage Fractures

Section snippets

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The operative management of flail chest injuries with concomitant sternal fracture

Chirurgia (Bucur)

Case report
Simultaneous Surgical Treatment of Sternum and Costal Cartilage Fractures