[Osteosynthesis with plates for full sternal dehiscence (Titanium Sternal Fixation System Synthes) -- first use in Hungary]

Sternal reconstruction using locking compression plates (LCP): our experience in Egypt, a case series

Background

Sternal fractures are rare accounting for about 3–8% of traumatic chest. There are many lines of treatments for sternal fractures which can be classified as conservative or surgical. Surgical techniques include wire fixation and sternal plating. There are no standardization of indications for each line of management.

We explore if sternal reconstruction using locking titanium plates and self-tapping screws provide the patient with the best chance of proper sternal healing avoiding chronic pain and its complications and allow the patient early mobilization and rapid restoring of his normal life at its maximum.

Methods

Our inclusion criteria are patients of both gender from 20 to 60 years of age presented with traumatic sternal fracture at any site or pathological fracture due to metastatic or primary tumors infiltrating the sternum. High Associated Injury Scale scores were excluded. Exclusion criteria also included patients younger than 20 years or older than 60 years. Primary outcome is post-operative pain score and is measured using numerical pain scale ranging from zero to 10 where zero means there is no pain at all and ten is the worst imaginable pain ever.

Results

Sternal reconstruction using titanium plates has proven to be an efficient method of stabilization with tremendous immediate relief of pain showed by the differences between pre-operative and post-operative pain scale scores in our patients (n = 5) with Median scores being 7 and 1.5 with range being from 7 to 9 and 1 to 3 respectively (p-value = .039). Operative time range between 150 min and 90 min with median of 120 min. Extubation of patients was smooth with no events with median time of extubation being 120 min. From our experience, there were no observed wound complications except at the third patient who suffered a small wound hematoma that was resolved by gentle compressing only and needed no further intervention.

Conclusion

We recommend adopting sternal reconstruction using titanium plating systems more readily encouraging even larger clinical trials on the way to a clear guidelines. Plating systems show promising results with least pain, better stability, less complications and rapid, smooth recovery.

Trial registration

NCT04092374

Flexible intramedullary nailing of a displaced transverse sternal fracture associated with a flexion-compression injury of the thoracic spine

STUDY DESIGN

A case report.

OBJECTIVE

To report the successful surgical management of a patient with a displaced sternal fracture associated with flexion-compression injury to the thoracic spine by flexible intramedullary nailing of the sternum, thereby emphasizing the existence and clinical relevance of the concept of the fourth column of the thoracic spine.

SUMMARY OF BACKGROUND DATA

Displaced sternal fractures resulting from indirect trauma are often associated with unstable injuries to the thoracic spine that require stabilization of the spine to prevent increasing kyphosis. The theory of the sternal-rib-complex as a possible fourth column giving structural support to the thoracic spine has been proposed. However, such a model has rarely been described, and the role of surgical stabilization of an unstable fourth column is unknown.

METHODS

A 58-year-old man with Forestier syndrome presented with a severely displaced sternal fracture associated with an unstable injury to the thoracic spine at T4-T8 after a fall at ground level. The patient complained of sternal pain and respiratory distress. However, neurologically he was completely normal. His pain and respiratory distress improved, so he refused spinal stabilization, and was discharged 20 days after the injury.

RESULTS

Eight weeks after the injury the patient complained of persistent sternal pain and symptoms of sternal instability. A computed tomogram (CT) showed increasing displacement of the sternal fracture and increasing kyphosis of the thoracic spine. To relieve the sternal pain and prevent further displacement the patient now agreed to stabilization of the sternal fracture by minimal invasive flexible intramedullary nailing. Postoperative CT showed an almost anatomically-reduced sternum and even a slight correction of the thoracic kyphosis. After removal of the implants 5 months later the patient was free of pain, and was able to resume normal physical activity and return to his work as a farmer. Thirty months after sternal stabilization surgery, CT showed complete healing of the sternal fracture and a continuing reduction of the thoracic kyphosis.

CONCLUSION

This case supports the concept of the existence and clinical relevance of the fourth column of the thoracic spine, and its role in giving added spinal stability.