Implant Failure: STRATOS System for Pectus Repair

Sharma, Prashant K.; Willems, Tineke P.; Touw, Daan; Woudstra, Willem; Erasmus, Michiel E.; Ebels, Tjark

doi:10.1016/j.athoracsur.2016.08.033

Cited by 15 publications

(7 citation statements)

References 7 publications

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“…The clamp systems are managed through similar approaches as the rib plates. They encompass the rib and generally require slightly extended intercostal dissection, which is not generally associated with a higher risk of a lesion of intercostal vessels or nerves, but the biomechanical properties are based on a different principle from that of the locked plate osteosynthesis with a considerable risc of implant failure (24,25). A retrosternal metal bar, as is very well known from the minimized pectus excavatum reconstructions according to Nuss, can also effect stabilization of the chest wall in certain cases.…”

Section: Discussionmentioning

confidence: 99%

The Operative Management of Flail Chest Injuries with Concomitant Sternal Fracture

Schulz-Drost¹,

Krinner²,

Langenbach³

et al. 2017

chr

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RezumatDate generale: Leziunile de volet costal (FCI) sunt unele dintre cele mai grave leziuni toracice. Mai mult decât atât, o fractură de stern suplimentară (SF) chiar agravează rezultatele, cum ar fi durata ventilaţiei mecanice, prin urmare o fixare chirurgicală a fracturilor poate fi luată în considerare în anumite cazuri pentru a grăbi deconectarea ventilatorului. Această lucrare urmăreşte să sublinieze managementul diferitelor tipuri de SF în FCI. Metode: Toate cazurile tratate chirurgical (2012)(2013)(2014)(2015)(2016) Original ArticleCuvinte cheie: volet costal, fractură de stern, fractură sternală, fractură costală, osteosinteză cu placă blocată, Matrix Rib Abstract Background: Flail Chest Injuries (FCI) are one of the most severe thoracic injuries. Moreover, an additional sternal fracture (SF) even worsens the outcome, such as the duration of mechanical ventilation, therefore an surgical fixation of the fractures could be considered in certain cases to improve the weaning from the ventilator. This paper aims to emphasize on the management of different types of SF in FCI. Methods: All surgically treated cases (2012)(2013)(2014)(2015)(2016) that showed the combination of FCI and SF have been evaluated for their clinical details, the morphology of the fractures and the technical aspects of the surgical procedure in a retrospective investigation.Results: All of the SF (n=15) had been fixed by locked plate osteosynthesis through a median approach in a supine position. Three main regions of the sternum showed the need for different fixation strategies: the upper manubrium, central and lower corpus sterni. Concomitant rib fractures were addressed either through the same approach or through additional limited incisions. Conclusions: Combinations of SF and FCI are high risc injuries with high demand on surgical skills. They can be properly fixed with a locking plate osteosynthesis through a combination of limited incisions employing different types of plates depending on the type of SF.

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Section: Discussionmentioning

confidence: 99%

The Operative Management of Flail Chest Injuries with Concomitant Sternal Fracture

Schulz-Drost¹,

Krinner²,

Langenbach³

et al. 2017

chr

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“…Long-term results with the Synthes® sternal titanium system and MatrixRIB® fixation system reports three implant failure on 27 patients (11%) ( 7 ). Also, implant failure was frequently reported in the follow-up of patients with pectus excavatum correction ( 11 , 19 ). In our study, the Thorib®/Trionyx® system seems to be very reliable provided fixation on the sternocostal cartilage is avoided.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes after chest wall resection and repair with titanium bars and sternal plates

et al. 2022

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ObjectivesEn-bloc complete resection remains the treatment of choice for localized chest wall (CW) tumors. Titanium bars reconstruction demonstrated encouraging results with satisfactory early outcomes. However, long-term outcomes remain under-reported. The purpose of this study is to evaluate long-term outcomes after CW resection and repair with titanium devices.MethodsFrom June 2012 to December 2018, we retrospectively reviewed all patients with CW tumors who underwent surgical resection and repair using titanium. Long-term outcomes were assessed.ResultsWe identified 87 patients who underwent CW tumor resections and titanium reconstruction. Sixty-eight patients were included in the study (excluding benign tumors, Pancoast tumors, palliative surgeries, or clavicle reconstruction). There were 29 sarcomas, 20 isolated CW metastases, eight lung cancers, four breast cancers, three thymic malignancies, two sarcomatoid mesothelioma, and one desmoid tumor. Complete resection was achieved in 64 patients (94%), while R1 resection in four patients (6%). Resection involved one rib in two patients, two ribs in thirteen, three ribs in eighteen, four ribs in nine, five ribs in two, seven ribs in one, partial sternum in fifteen, and full sternum in sixteen patients. No patient experienced flail chest. The 1-year, 3-year, and 5-year overall survival rates and disease-free survivals were 82.3%, 61.4%,57.3%, and 67.6%,57.3%,52.6%, respectively. Surgical site infection occurred in 18% (n = 12) of cases. Eleven of twelve patients had an early infection (<1 year), which required material removal in six patients. Asymptomatic connector unsealing occurred in 6% (n = 4), with only one re-intervention. Titanium allergy has never been reported. Chronic chest pain (lasting more than 3 months after surgery, with daily use of pain killer) was reported in 24% of patients. ConclusionCW resections with titanium reconstruction are associated with long-term survivors. Titanium devices were safe, reliable, and achieved satisfactory oncological results with low morbidity and implant-related complication rates.

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“…Limitations of these techniques are the provided relative stability, increasing the risk of mal-union or non-union, as well as the need for implant removal in case of temporary fixation which leads to a high reoperation rate. A recent article describes a 100% failure rate of using a combination of steel wires and substernal STRATOS bars in 12 patients, all requiring reoperation (15).…”

Section: Challenges In the Ravitch Technique Are Preservation Of The Corrected Position Of The Sternum And Achieving Union Of The Osteotomentioning

confidence: 99%

Does the use of locking plates or mesh and wires influence the risk of symptomatic non-union of the sternal osteotomy after modified Ravitch?

et al. 2020

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Background: Patients with pectus excavatum which is unsuitable for minimally invasive repair are usually treated by modified Ravitch procedure. For fixation of the sternal osteotomy, mesh and wires are mostly used. To decrease non-union risk, we introduced a technique with double locking plate fixation of the osteotomy and compared this to fixation using mesh and wires.Methods: Patients undergoing a modified Ravitch procedure for pectus excavatum between 2006 and 2016 were included. From 2006 to 2012, the sternum was fixated with mesh and wires. From 2012 to 2016, locking compression plates (LCP) were used. Baseline parameters, symptomatic non-union and total number of complications were retrospectively compared. Statistical analysis was performed using Mann-Whitney or Fisher's exact test. Data are presented as means +/− SD.Results: Forty-four patients were included. In 18 patients, the sternum was fixed with mesh and wires, in 26 patients with LCP. Mean follow-up was 35 months in the mesh and 30 months in the LCP group, P=0.71. Haller index was similar in both groups (mesh 3.8±1.3 vs. LCP 3.9±1.1, P=0.81). Symptomatic nonunion occurred in 17% (n=3) in the mesh group and did not occur after LCP, P=0.062. Total number of complications was 33% (n=6) in the mesh group and 15% (n=4) after LCP, P=0.27. Conclusions: After modified Ravitch procedure, union of the sternal osteotomy is challenging. In this retrospective cohort study, a lower incidence of symptomatic non-union was observed after fixation of the sternum with LCPs, with a trend towards statistical significance.

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Implant Failure: STRATOS System for Pectus Repair

Cited by 15 publications

References 7 publications

The Operative Management of Flail Chest Injuries with Concomitant Sternal Fracture

The Operative Management of Flail Chest Injuries with Concomitant Sternal Fracture

Long-term outcomes after chest wall resection and repair with titanium bars and sternal plates

Does the use of locking plates or mesh and wires influence the risk of symptomatic non-union of the sternal osteotomy after modified Ravitch?

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