In Situ Reconstruction of a Painful Sternal Z-Deformity Nonunion in a Severely Osteoporotic and Kyphotic Patient

Mavrommatis, Sophia; Thomas, Claire N.; Schroder, Lisa K.; Cole, Peter A.

doi:10.2106/jbjs.cc.21.00231

Cited by 1 publication

(4 citation statements)

References 14 publications

(52 reference statements)

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“…Research on the treatment and outcomes of patients with a reconstruction of a sternal nonunion due to trauma is minimal and is limited to case reports and case series. [9][10][11][12][13][14][15][16][17] Posttraumatic sternum nonunion can be an extremely debilitating pathology that dramatically impacts patient well-being, both physically and mentally. 8 These patients may suffer from symptoms including extreme pain, feelings of instability, and depression, among others.…”

Section: Discussionmentioning

confidence: 99%

“…Research on the treatment and outcomes of sternal nonunion reconstruction has primarily been completed on patients who have underwent sternotomy. Research on the treatment and outcomes of patients with a reconstruction of a sternal nonunion due to trauma is minimal and is limited to case reports and case series 9–17 …”

Section: Discussionmentioning

confidence: 99%

“…Several solutions for nonunion reconstruction have been proposed in the literature, most of which have been directed towards and studied on patients after sternotomy. Very little work has been published on reconstruction of sternal nonunion as a result of trauma 9–17 …”

mentioning

confidence: 99%

“…Very little work has been published on reconstruction of sternal nonunion as a result of trauma. [9][10][11][12][13][14][15][16][17] The purpose of this current study is to describe the surgical principles and report clinical outcomes including union rate, complications, and patient reported outcomes (patient-reported outcomes measurement information system [PROMIS] 18 ; single assessment numeric evaluation [SANE] 19 ) in a series of 7 patients undergoing surgical reconstruction of a traumatic sternal body nonunion.…”

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confidence: 99%

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Surgical management of traumatic sternal body nonunions: Technical tricks and clinical experience

Laroque¹,

Brahme²,

Cole³

2023

J Trauma Acute Care Surg

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BACKGROUND Rarely, traumatic sternum fractures may result in nonunion, which can have drastic, negative implications. Literature on traumatic sternal nonunion reconstruction outcomes is limited to case reports. We present the surgical principles and report clinical outcomes for seven patients following surgical reconstruction of a traumatic sternal body nonunion. METHODS Consecutive adult patients with a nonunion after a traumatic sternum fracture who underwent reconstruction using locking plate technology and iliac crest bone graft at a Level I trauma center from 2013 to 2021 were identified. Demographic, injury, and surgery data was collected, and postoperative patient-reported outcome (PRO) scores were obtained. Patient-reported outcome scores included the one-question single assessment numeric evaluation (SANE), and the combined 10-question global physical health and global mental health values. Injuries were classified and all fractures were mapped onto a sternum template. Postoperative radiographs were reviewed for union. RESULTS Of the study's seven patients, five were female, and the mean age was 58 years. Mechanism of injury included motor vehicle collision (5) and blunt object chest trauma (2). The mean time from initial fracture to nonunion fixation was 9 months. Four of the seven patients achieved in-clinic follow-up at ≥12 months (mean = 14.3 months), while the other three achieved ≥6 months of in-clinic follow-up. Six patients completed outcomes surveys ≥12 months after surgery (mean = 28.9 months). Mean PRO scores at final follow-up included: SANE of 75 (out of 100), and global physical health and global mental health of 44 and 47, respectively (US population mean = 50).Six of seven patients achieved known radiographic union. CONCLUSION We describe an effective and practical method of achieving stable fixation in traumatic sternal body nonunions as evidenced by the positive clinical outcomes of a seven-patient series. Despite the variation in presentation and fracture morphology of this rare injury, the surgical technique and principles outlined can serve as a useful tool for chest wall surgeons. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.

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