Transverse Sternal Nonunion, Repair and Revision: A Case Report and Review of the Literature

Severson, Erik P.; Thompson, Corey A.; Resig, Scott; Swiontkowski, Marc F.

doi:10.1097/ta.0b013e318047dfd9

Cited by 15 publications

(20 citation statements)

References 10 publications

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“…Confirmation of bone healing in all of these applications is of value, as nonunion can lead to complications such as infection, pain, and limited function [20][21][22][23][24]. CT is an excellent imaging modality for evaluation of bone healing.…”

Section: Commentmentioning

confidence: 99%

Evaluation of Sternal Bone Healing with Computed Tomography and a Quantitative Scoring Algorithm

Stacy¹,

Ahmed²,

Richardson³

et al. 2014

TOMIJ

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Abstract:Objective: The exquisite bone detail offered by computed tomography makes it the ideal modality for evaluation of bone healing. However, few studies have investigated the normal computed tomographic appearance of the sternum after median sternotomy and, to the best of our knowledge, no computed tomographic classification of sternal healing has been proposed. Given the potential benefit of objective criteria, we propose a validated scoring classification of sternal healing using computed tomography for both clinical and investigational purposes.Methods: Computed tomography scans from 20 patients who underwent a median sternotomy were evaluated for sternal healing at either 3 or 6 months postoperatively. Five anatomic locations along the sternum were selected using defined criteria, and a 6-point quantitative scale was developed to evaluate sternal healing. Independent radiologists read and scored each of the 5 locations on the sternum. Inter-and intra-observer variability was assessed by calculating the kappa statistics to measure the reliability of the scoring algorithm.Results: Calculation of the kappa statistics indicated substantial agreement for intra-observer variability and substantial to almost perfect agreement for inter-observer variability. For intra-observer variability, the kappa statistics ranged from 0.591 to 0.802, and for inter-observer variability, the kappa statistics ranged from 0.590 to 0.969. When the two radiologists differed, the magnitude of the difference was no more than 1 or 2 points. Conclusion:This simple system of evaluating sternal healing had high inter-and intra-observer reliability. Therefore, it may be considered a valid method for assessing sternal osteosynthesis for both clinical and investigative purposes.Ultramini abstract: (49 words): Few studies have investigated the normal computed tomography appearance of the sternum after median sternotomy, and we knew of no computed tomography-based classification of sternal healing. Given the potential benefit of objective criteria, we designed and validated a scoring classification of sternal osteosynthesis for both clinical and investigational purposes.

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Section: Commentmentioning

confidence: 99%

Evaluation of Sternal Bone Healing with Computed Tomography and a Quantitative Scoring Algorithm

Stacy¹,

Ahmed²,

Richardson³

et al. 2014

TOMIJ

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“…The reason for preferring locking compression plate over the steel wires in our case was the former is much safer if performed under fluoroscopic guidance, taking care not to push screws much beyond posterior cortex; approximates bone closely and it requires minimal dissection of tissues, hence less interruptions in the blood supply of sternum as compared to latter [8][9][10]. Moreover, the previous experience with sternal wires, as reported by Salloum W et al [1], was not good, as they had to remove the wires and apply a metallic plate for fixation two months after initial fixation by wires.…”

Section: Discusionmentioning

confidence: 99%

Surgical Management of Traumatic Manubrio-Sternal Dislocation With Locking Compression Plate; A Case Report and Review of Literature.

Shaikh¹,

Shahabuddin²,

Rashid³

et al. 2017

Int J Med Rev Case Rep

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Background: Manubriosternal joint dislocation as a result of trauma is rare with only few case reports published in the literature. Materials that have been used for fixation of displaced manubriosternal joint are steel wires, polydioxanone ropes, and plates with screws. Case: We present a case of manubriosternal dislocation in which fixation was done with locking compression plate. It is a case of 32-years-old lady with a history of road traffic accident; car ran over her chest. She had multiple bilateral rib fractures and manubriosternal joint dislocation of type-I. The patient was initially stabilised in high dependency unit, and once her contusions got better, she underwent fixation of her manubriosternal dislocation with locking compression plate. Post-operatively she remained pain-free and was discharged home. Conclusion: This case is an important addition to literature regarding options that can be used for fixation of manubriosternal joint dislocation.

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“…Traumatic sternal fractures are usually the result of motor vehicle accidents where direct impact from the steering column causes posterior displacement of the distal sternal fragment. 10,11 Risk factors for sternal nonunion after median sternotomy are classified either as extrinsic or intrinsic although failure is likely multifactorial. Extrinsic factors include preexisting patient conditions and intraoperative and postoperative events.…”

mentioning

confidence: 99%

Late Complications of Chest Wall Reconstruction: Management of Painful Sternal Nonunion

Chepla¹,

Salgado²,

Tang³

et al. 2011

Seminars in Plastic Surgery

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Although rare, sternal nonunion after median sternotomy or traumatic injury is associated with a high rate of morbidity. Pain and sternal clicking are two of the most common complaints and reasons these patients seek evaluation and treatment. Diagnosis of sternal nonunion is based on a thorough history and physical examination and can be confirmed with subsequent radiographic imaging. The treatment for symptomatic sternal nonunion requires stable fixation of the bony fragments and chest wall after the debridement of all nonviable bony and soft tissue by the cardiothoracic or reconstructive surgery team. Multiple fixation techniques have been described and incorporate a wide variety of materials including combinations of wires, cables, pins, bands, staples, and plates. Most recently, several new commercially available plating systems have demonstrated low recurrence and complication rates and resolution of the patient's symptoms on follow-up evaluation. Included in this review are three cases demonstrating the management of symptomatic sternal nonunion using these new techniques and review the history, diagnosis, risk factor, and classification, as well as several of the previously described fixation methods.

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Transverse Sternal Nonunion, Repair and Revision: A Case Report and Review of the Literature

Cited by 15 publications

References 10 publications

Evaluation of Sternal Bone Healing with Computed Tomography and a Quantitative Scoring Algorithm

Evaluation of Sternal Bone Healing with Computed Tomography and a Quantitative Scoring Algorithm

Surgical Management of Traumatic Manubrio-Sternal Dislocation With Locking Compression Plate; A Case Report and Review of Literature.

Late Complications of Chest Wall Reconstruction: Management of Painful Sternal Nonunion

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