Sternal plating for primary and secondary sternal closure; can it improve sternal stability?

Fawzy, Hosam; Alhodaib, Nasser I.; Mazer, C. David; Harrington, Alana; Latter, David A.; Bonneau, D.; Errett, Lee; Mahoney, James

doi:10.1186/1749-8090-4-19

Cited by 52 publications

(55 citation statements)

References 17 publications

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“…On the retreat of the operation, the sternotomy can be correspondingly stabilized with the additional fractures of the anterior chest wall. For example, a plate osteosynthesis over the sternotomy represent a sufficient method to address the rotatory instability analogous to the above-described manubrium fractures (23).…”

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

View full text Add to dashboard Cite

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“…The plate fixation from a biomechanical point of view is the more stable option. This has already been demonstrated in sternum closure after median sternotomy [12].…”

Section: Introductionmentioning

confidence: 79%

“…Analogous to median sternotomy closure, plate fixation of sternal fractures seem to provide the most stable method with the best alignment of the fragments [12]. However, in order to fix the plate to the bone, drill holes and screws are required.…”

Section: Introductionmentioning

confidence: 99%

Surgical fixation of sternal fractures: locked plate fixation by low-profile titanium plates—surgical safety through depth limited drilling

Schulz-Drost

Mauerer

Grupp

et al. 2013

International Orthopaedics (SICOT)

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Purpose Operative treatment of sternal fractures has become a matter of increasing interest. Anterior plating seems to be the most appropriate method for fixing sternal fractures. However, there are several concerns in relation to the operative procedure such as severe injuries to mediastinal organs, patient comfort and proper stabilisation, for example. This paper describes a safe method of anterior sternal plating using locked plate fixation with limited depth drilling. Methods Ten patients with sternal fractures were included in this cohort study and were treated by anterior plating using one or two plates in parallel through a median approach to the sternum. Follow up was performed after six weeks, 12 weeks and six months. Results Follow up revealed no serious complications. One patient suffered from postoperative wound seroma. No problems were caused by the plates. Conclusions Sternal plating using low profile locked titanium plates seems to be a safe and stable method with a high level of patient comfort.

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“…Two of them showed two oblique fractures originating from the first intercostal space and unifying in the middle towards the jugulum (cases 21,22). This triangle type fracture is equivalent to instability of both shoulder girdles combined with a sagittal instability.…”

Section: Schulz-drost Et Al Different Types Of Manubrium Sterni Fracmentioning

confidence: 99%

Fractures of the manubrium sterni: treatment options and a possible classification of different types of fractures

et al. 2018

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Background: Sternum fractures are mostly located on the sternal corpus, seldom on the manubrium.Fractures of the sternal manubrium are, however, more frequently associated with severe concomitant injuries of thoracic organs, and therefore deserve special attention. In addition, in its function as a capstone in between the anterior chest wall and the shoulder girdle, it is exposed to a multiplicity of forces. Therefore the questions arise what types of fractures are observed in today's clinical practice, how to classify them and which treatment options are available. This study reports on different types of fractures which involve the manubrium sterni. Methods: Between January 2012 and October 2014, data was collected from all severely injured patients (ISS ≥16), which received a CT scan of the thorax in our Level-I-Trauma Center and retrospectively analyzed concerning sternal fractures. Fracture type, collateral injuries, age, and information about the circumstances of the accident were noted. Results: Of 890 evaluable patients, 154 (17.3%) had a fracture of the sternum and 23 (2.6%) of the manubrium. Fractures of the manubrium appeared in following types: A-type-transverse fracture (n=11) in 1st intercostal space by direct blunt trauma or flexion of the torso with sagittal instability; B-type-oblique fracture (n=9) by seat belt injury with rotatory instability; C-type-combined, more fragmentary fracture (n=3) by direct blunt trauma with simultaneous flexion of the torso and multi directional instability. Fractures only little dislocation were treated conservatively, and unstable fractures were surgically stabilized (n=10). Conclusions: In summary, three main types of fractures could be found. A-type fractures were stabilized with a longitudinal plate osteosynthesis and B-type fractures with transverse positioned plates. To treat complex C-type fractures, plates with a T-or H-form could be a good solution.Level of evidence: Level III retrospective prognostic cohort study

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Sternal plating for primary and secondary sternal closure; can it improve sternal stability?

Cited by 52 publications

References 17 publications

The Operative Management of Flail Chest Injuries with Concomitant Sternal Fracture

The Operative Management of Flail Chest Injuries with Concomitant Sternal Fracture

Surgical fixation of sternal fractures: locked plate fixation by low-profile titanium plates—surgical safety through depth limited drilling

Fractures of the manubrium sterni: treatment options and a possible classification of different types of fractures

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