Operative treatment of multiple costochondral dislocations in a patient with severe rib fractures and a flail chest following trauma

Abstract

A 73-year-old male patient underwent operative treatment for dislocation of multiple costochondral junctions alongside multiple bony rib fractures and a flail chest following high-energy trauma. During the operative fixation of the flail chest, the costochondral lesions were surgically stabilised with plates and screws, which were fixated on the osseous anterior rib, sternum or the rib cartilage. The patient experienced no pulmonary complications during the primary admission. At 7 months after the trauma, the chest CT scan showed full consolidation of all fixated rib fractures, including the costochondral lesions, without hardware dislocation or complications. The patient did not require any pain medication and had no pain during daily activities, at rest or at night. Although being a biomechanically demanding region, which is often not defined in current rib fracture classification, operative treatment of costochondral lesions is feasible with outcome similar to the treatment of bony rib fractures.

Open Reduction and Internal Fixation of a Chronic Precordial Flail Chest Segment

“…With multiple nonunions and dislocations resulting essentially in a flail segment, his symptoms were unsurprising. Similar cases have been described in which patients suffering from multiple thoracic injuries underwent operative fixation with improved outcomes after reconstruction of rib fractures, costosternal nonunions, and costal cartilage fractures 3,5,[13][14][15]18 . Surgical reconstruction of flail chest pathology has also demonstrated improvements in postoperative pulmonary function 19 .…”

“…This anatomic region has also been described as small and biomechanically demanding, thus increasing the complexity of an operation. An increased recognition of cartilage injuries has prompted an interest in operative fixation outcomes [7][8][9][10][11][12][13][14] . Consequently, there is growing evidence that earlier fixation for costochondral fractures can significantly benefit patients, preventing long-term complications of pain and decreased function 5,[11][12][13][14] .…”

“…An increased recognition of cartilage injuries has prompted an interest in operative fixation outcomes [7][8][9][10][11][12][13][14] . Consequently, there is growing evidence that earlier fixation for costochondral fractures can significantly benefit patients, preventing long-term complications of pain and decreased function 5,[11][12][13][14] .…”

“…The costochondral junction is a synchondrosis joint, and injuries to this joint should be diagnosed as costochondral subluxations or dislocations 10 . Unfortunately, there is limited literature regarding outcomes of surgical fixation of the costochondral junction, although these injuries affect long-term patient well-being 3,4,[11][12][13][14][15][16][17] .…”

Costal margin injuries and trans-diaphragmatic intercostal hernia: Presentation, management and outcomes according to the Sheffield classification

“…These may well heal without surgical intervention, so it is our practice to counsel and observe the patient initially, reserving surgical stabilization to those undergoing thoracic surgery for another indication (e.g., SSRF), or who remain symptomatic after failure of nonoperative management. Plate fixation of the costal margin is feasible and safe in selected cases, without the need to span the cartilage from ribs to sternum 17,18 …”