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

Schulz-Drost, Stefan; Mauerer, Andreas; Grupp, Sina; Hennig, F. F.; Blanke, Matthias

doi:10.1007/s00264-013-2127-7

Cited by 15 publications

(12 citation statements)

References 19 publications

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“…Previously described dislocations of wires with sometimes severe intrathoracic injuries are thus excluded, a material failure and a secondary dislocation are minimized. A further safety aspect, also particularly for the inexperienced surgeon, is the depth limited drilling of the system (22). Thus, the thickness of the sternum or rib is determined at each region to be treated and a corresponding In the treatment of chest wall fractures, accompanying intrathoracic injuries must, of course, also be included.…”

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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“…The sternal anatomy and the stability of the anterior chest wall are restored by a stable fixation employing a locked plate osteosynthesis. Using very slim plates (1.5 mm or 2.0 mm thickness) provides a proper stability on the one hand and high convenience for the patient on the other hand 12 .…”

Section: Discussionmentioning

confidence: 99%

“…As indications for surgical treatment the unstable anterior chest wall needs to be considered as well as fracture displacement and a persistent, painful instability of more than seven days 7,12 . Once the decision for surgery of the sternal fracture is made, a reassessment of any concomitant injury should be performed, in order to put the treatment of multiple injuries in an appropriate sequence.…”

Section: Diagnosis Assessment and Planmentioning

confidence: 99%

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Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling

Schulz-Drost

Oppel

Grupp

et al. 2015

JoVE

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Different ways to stabilize a sternal fracture are described in literature. Respecting different mechanisms of trauma such as the direct impact to the anterior chest wall or the flexion-compression injury of the trunk, there is a need to retain each sternal fragment in the correct position while neutralizing shearing forces to the sternum. Anterior sternal plating provides the best stability and is therefore increasingly used in most cases. However, many surgeons are reluctant to perform sternal osteosynthesis due to possible complications such as difficulties in preoperative planning, severe injuries to mediastinal organs, or failure of the performed method.This manuscript describes one possible safe way to stabilize different types of sternal fractures in a step by step guidance for anterior sternal plating using low profile locking titanium plates. Before surgical treatment, a detailed survey of the patient and a three dimensional reconstructed computed tomography is taken out to get detailed information of the fracture's morphology. The surgical approach is usually a midline incision. Its position can be described by measuring the distance from upper sternal edge to the fracture and its length can be approximated by the summation of 60 mm for the basis incision, the thickness of presternal soft tissue and the greatest distance between the fragments in case of multiple fractures.Performing subperiosteal dissection along the sternum while reducing the fracture, using depth limited drilling, and fixing the plates prevents injuries to mediastinal organs and vessels.Transverse fractures and oblique fractures at the corpus sterni are plated longitudinally, whereas oblique fractures of manubrium, sternocostal separation and any longitudinally fracture needs to be stabilized by a transverse plate from rib to sternum to rib. Usually the high convenience of a patient is seen during follow up as well as a precise reconstruction of the sternal morphology.

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“…Plates with locking screws have proven to be the method of choice for osteosynthesis of sternal fractures (15,16). Sagittal dislocations can be avoided by applying a longitudinal plate.…”

Section: Introductionmentioning

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

Cited by 15 publications

References 19 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: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling

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

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