Video-Assisted Thoracoscopic Surgical Rib Fixation for Costochondral Separation Injury

Geraedts, Tessa C.M.; Daemen, Jean H. T.; Vissers, Yvonne L. J.; Loos, Erik R. de

doi:10.1177/15569845211049245

Cited by 2 publications

(5 citation statements)

References 13 publications

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“…Diagnosis and treatment of costal margin and costochondral related injuries remains challenging for clinicians managing patients in both the acute and chronic setting with various intervention techniques presented for specific injury locations along the anterior chest wall and for particular pathology. 1,8,[10][11][12]17 In this study, we expanded upon previous cadaveric work which identified variability from traditional chest wall anatomy teaching in regard to the 9th and 10th ribs with identification of increased anatomic predisposing factors which may contribute to slipped rib syndrome. 13 We have expanded on this initial data by focusing this study on chondral attachments and the costal margin in order to correlate with additional clinical syndromes.…”

Section: Discussionmentioning

confidence: 99%

Anatomy of the anterior ribs and the composition of the costal margin: A cadaver study

Patel,

Privette,

Bauman

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND Traditional rib anatomy and costal margin teaching contends that the costal margin consists of a combined costal cartilage made up of ribs 7 to 10. Variations in 9th and 10th rib anatomy have been observed. We sought to evaluate the variability of interchondral joints and the make-up of the costal margin. METHODS Cadaveric dissections were performed to evaluate the anatomy of the anterior ribs and the composition of the costal margin. Experienced chest wall surgeons evaluated this anatomy through a standardized dissection and assessment. Dissection videos were performed to allow for further review/assessment. RESULTS Bilateral chest wall anatomy of 30 cadavers was evaluated (15 male, 15 female). The average age was 78 ± 12 years, and all patients were Caucasian. In all patients, the first rib attached to the manubrium, the second rib attached to the manubriosternal junction, and ribs 3 to 6 attached directly to the sternum. Interchondral joints were present between ribs 4/5—3%, 5/6—68%, 6/7—83%, 7/8—72%. Ribs combining to form a common costal cartilage via cartilaginous unions were observed between 6/7—3%, 7/8—45%, 8/9—30%, and 9/10—20%. The 8th rib attached directly to the sternum without joining the 7th rib in 10% of cadavers. The 8th and 9th ribs had free tips in 45% and 60% of evaluations, respectively. The 10th rib was found to have a hooked tip in 25% of cases and was a floating rib without attachment to the 9th rib 52% of the time. Rib tip mobility was noted in ribs 8, 9, and 10 in 52%, 70%, and 90%, respectively. CONCLUSION Interchondral joints are common between ribs 5 and 8. Significant variability exists in the chest wall and costal margin compared with traditional teaching. It is important for chest wall surgeons treating diseases of the costal margin to appreciate this anatomic variability.

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Section: Discussionmentioning

confidence: 99%

Anatomy of the anterior ribs and the composition of the costal margin: A cadaver study

Patel,

Privette,

Bauman

et al. 2023

J Trauma Acute Care Surg

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“…Costochondral separation occurs following blunt thoracic trauma and is precipitated by multiple costochondral fractures resulting in the separation of costal cartilage from the sternum. This can lead to instability of the rib cage and potential compression of superior mediastinal structures [ 2 ]. Costochondral fractures are present in about 42% of patients who experience blunt chest trauma and are more common in elderly patients with calcification of the costal cartilage [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Video-assisted thoracoscopic surgery (VATS) has been used to provide a dynamic intraoperative evaluation of chest wall instability, plan the approach for fixation, and assess for associated injuries, which allows for direct minimally invasive repair. Although it is mainly diagnostic, adding VATS to surgical rib fixation for patients with costochondral separation is highly beneficial for therapeutic purposes as well, as it allows the evacuation of hemothorax, flushing of the thoracic cavity, and the administration of intercostal analgesia under direct vision [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Surgical rib fixation has emerged as a viable treatment option for patients with costochondral separation, especially in cases with severe symptoms or complications [2][3][4]. In such cases, surgical fixation can restore rib cage stability and alleviate the pain and distress associated with the condition, guiding patients' return to normal physiologic function.…”

Section: Discussionmentioning

confidence: 99%

“…The research surrounding this injury pattern and its management is limited, most likely due to its rare occurrence. Surgical rib fixation has been shown to effectively treat multiple rib fractures and flail chest in patients with costochondral separation [2][3][4][5]. Complications and outcomes associated with the procedure are subjects of ongoing research.…”

Section: Introductionmentioning

confidence: 99%

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Management of a Flail Chest Caused by Multiple Costosternal Fractures: A Case Report

Taylor,

Miller,

Azani

et al. 2023

Cureus

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Costochondral separation is a rare consequence of blunt thoracic trauma and can lead to life-threatening complications such as a flail chest. The diagnosis of costochondral separation remains challenging due to the obscurity of the condition on chest radiographs. Surgical rib fixation is a viable treatment option and research regarding its effectiveness and long-term benefits is promising but still evolving. Here, we discuss a case of flail chest caused by multiple costosternal fractures definitively managed with surgical rib fixation.

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Video-Assisted Thoracoscopic Surgical Rib Fixation for Costochondral Separation Injury

Cited by 2 publications

References 13 publications

Anatomy of the anterior ribs and the composition of the costal margin: A cadaver study

Anatomy of the anterior ribs and the composition of the costal margin: A cadaver study

Management of a Flail Chest Caused by Multiple Costosternal Fractures: A Case Report

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