[Sternal fracture in growing children : A rare and often overlooked fracture? Documentation of four cases]. / Sternumfraktur im Wachstumsalter : Eine seltene oder häufig übersehene Fraktur? Dokumentation von 4 Fällen.

BACKGROUND: Sternal fractures in childhood are rare. The aim of the study was to investigate the accident mechanism, the detection of radiological and sonographical criteria and consideration of associated injuries. METHOD: In the period from January 2010 to December 2012 all inpatients and outpatients with sternal fractures were recorded according to the documentation. RESULTS: A total of 4 children aged 5-14 years with a sternal fracture were treated in 2 years, 2 children were hospitalized for pain management and 2 remained in outpatient care. CONCLUSION: Isolated sternal fractures in childhood are often due to typical age-related traumatic incidents. Ultrasonography is a useful diagnostic tool for fracture detection and radiography is the method of choice for visualization of the extent of the dislocation.

Left-sided approach for cardiac procedure and thoracoplasty in a patient with Marfan syndrome.

We present a case of a 20-year-old female in whom we successfully performed a simultaneous Bentall procedure and thoracoplasty by initially removing only the left side of the costal cartilages. This modified sternal elevation technique offered chest stability and an excellent surgical view, and the postoperative course was satisfactory.

Combined surgical correction of pectus carinatum and juvenile kyphosis.

Pectus carinatum may rarely be associated with kyphosis. However, the correlation between both conditions is not well reported. Therefore, there are no reports for combined correction of both deformities in the same patient. Moreover, studies estimating the kyphosis prevalence in patients with pectus carinatum are lacking. To our knowledge, this is the first paper to present such a case. We report an 18-year-old boy with both pectus carinatum and kyphosis that were surgically corrected in a combined procedure. The indication of surgery is cosmetic, and the postoperative recovery included pneumothorax but was otherwise uneventful and satisfactory.

Complex open sternal fracture with impingement of the pericardium.

The incidence of sternal fracture ranges from 3 to 8%. In more than half, they are associated with other organ trauma such as blunt cardiac injuries, rib, scapular or vertebral fractures. Hence, the presence of sternal fracture is considered a marker for significant transmission of energy. The management of isolated sternal fractures is usually non-operative with surgery reserved for displaced fractures or in cases of respiratory insufficiency. However, management may become challenging when they are associated with other significant trauma. We discuss a case of sternal fracture complicated by the presence of blunt cardiac injury, open pneumothorax, rib fractures, anterior flail chest and empyema.

Early surgical repair of isolated traumatic sternal fractures using a cervical plate system.

BACKGROUND: We reviewed our experience of the surgical management and follow-up of patients admitted with an isolated traumatic sternal fracture (TSF) to a Thoracic Surgical Unit through the Emergency Department. METHODS: During a 5-year period, six patients were surgically treated for an isolated TSF. Presence of physical deformity or acute and persistent pain were considered indications for surgical repair. Surgical repair was performed within 1 week from the trauma by means of a titanium cervical plate system currently in use in spine surgery. RESULTS: There were no postoperative complications. Mean hospital stay was 3 days. All patients showed regular sternal healing at 6 to 8 weeks. In one patient the plate was removed after 3 years because of persistent chest discomfort. CONCLUSIONS: Early surgical repair of isolated TSF is advocated in cases of physical deformity or acute and persistent pain. The titanium cervical plate system provides effective repair of the fracture with satisfactory long-term results.

Excavated-type of rhomboid fossa of the clavicle: a radiological study.

The excavated type of rhomboid fossa of the clavicle is a relatively neglected anatomical structure that can potentially cause diagnostic problems. Its unilateral occurrence may be confused by the physician as avascular necrosis, osteomyelitis, or even a tumour. We studied 80 routine chest radiographs and identified the clavicles with excavated type of rhomboid fossa. The sex, sidedness, and handedness were recorded. An excavated type of rhomboid fossa was present in 43 clavicles (26.88%), appearing more frequently in males than in females. In addition, the incidence of the excavated type of rhomboid fossa was greater on the right side than on the left. That type of fossa was also present more frequently on the right side in right-handed specimens and on the left side in left-handed specimens. The high incidence of the excavated type of rhomboid fossa on the dominant hand supports the mechanical theory of fossa formation. Radiologists and physicians should be aware of this fossa, as it may resemble a pathological condition.

Thoracoscopy-assisted repair of comminuted sternal fracture with bioresorbable plates.

We present a case of comminuted sternal fracture with posterior displacement, which was successfully repaired by 'sandwich' fixation using 2 bioresorbable plates that were placed anterior to and posterior to the sternum. All procedures including retro-sternal dissection for placement of the posterior plate were performed using video-assisted thoracoscopic surgery. The minimally invasive thoracoscopic technique provided effective repair and rigid fixation with immediate relief from intractable chest pain that had persisted before surgery.

Impending rupture of aortic aneurysm eroding skin and sternum: a rare condition.

A rare presentation of ascending aortic aneurysm eroding into the anterior chest wall and skin is described. Only a few reports of this lethal condition associated with luetic disease have been published previously. A 72-year-old man with a history of blunt chest injury subsequently developed a saccular aneurysm of the ascending aorta protruding out of the anterior chest wall. He was successfully treated with a surgical intervention.

Osseous Hodgkin's lymphoma-review of literature and report of an unusual case presenting as a large ulcerofungating sternal mass.

Osseous involvement in Hodgkin's lymphoma is uncommon. The most common location is vertebral, primarily in the thoracolumbar region, followed by pelvis, ribs, femur, sternum, clavicle and skull in decreasing incidence. We herein illustrate the salient features of the disease citing a case of a disseminated Hodgkin's lymphoma presenting as a large ulcerofungating sternal mass mimicking chronic tubercular osteomyelitis. The case report highlights the importance of clinical suspicion of unusual presentation of lymphohematopoietic tumors of the bone especially in developing countries, where chronic granulomatous disease is preponderant.

[Particular localisation of hydatic disease--sternum]. / Localizare particulara a bolii hidatice la om--sternul.

Bones localization of hydatic disease is extremely rare (0.5-2.5 %). In approximative 50% of the cases of bones hydatidosis, the cysts are localized at spines vertebrae, broad bones and mandible. We present a case of a 38 years old female. The patient related an insidious beginning of symptoms, about 3-4 years before, with anterior chest pain, and 3-4 month before hospitalization, the presence of a sternal tumor, in upper portion of the bone. Clinical examination of the patient showed a sternal tumor, at manubrium, painful at palpation, increased consistency, with local inflammation signs. Also, the patient related pain at sterno-clavicular articulation, increased by left upper limb motions, but without mobility restriction. Biochemical analysis revealed an moderate inflammatory syndrome: blood cell sedimentation speed = 40 mm/h, WBC = 9600/mmc, E = 3%, Hb = 11.8g/100ml, alcaline and acid phosphatase - normal range. Thoracic scan: sternal tumor at manubrium with invasion at sternoclavicular joint and bone destruction. Intraoperative we discovered that the sternal tumor was in fact an hydatic cysts, confirmed by the anatomo-pathological exam; we performed cysts removal and resection of osteitic bone. Postoperative outcome was favorable, with antiparasitic treatment after surgery; no recurrence of the hydatic disease or secondary localization.

Uncommon cause of chest pain in a postoperative spinal patient.

An 84-year-old woman with previous spinal operations including vertebroplasty and lumbar decompressions was admitted electively under the spinal team for right-sided L4/5 decompression for worsening back pain which she undergoes using a posterior approach. Postoperatively, she develops stabbing upper central chest pain and given unremarkable chest X-ray, ECG and cardiac troponin, she undergoes a CT pulmonary angiogram which shows a fracture of the upper part of sternum but no pulmonary embolism. There is no history of recent trauma and this is deemed to be secondary to prolonged spinal surgery in the prone position in a patient with osteopenic bones. To date, we have not come across a case of spontaneous sternal fracture as a complication of spinal surgery at our regional spinal unit. Most cases of sternal fractures are secondary to blunt anterior chest wall trauma with spontaneous fractures and stress fractures being rare.

Technical consideration of the MOVARPE technique in intricate pectus excavatum deformity.

BACKGROUND: For the correction of pectus excavatum (PE) deformities in adolescents, adults, and generally in asymmetric cases, a semi-open approach called the MOVARPE (minor open videoendoscopically assisted repair of pectus excavatum) technique is used, consisting of standard pectus bar implantation hybridized with auxiliary sternum osteotomy and multiple chondrotomies. In this study, we report our experiences, discuss pros and cons, and provide technical refinements. METHODS: Between September 2005 and March 2015, 61 patients were selected to undergo the MOVARPE instead of the standard MIRPE (minimally invasive repair of pectus excavatum) procedure because of age or specific morphologic characteristics of PE. Patient age ranged from 14 to 45 years (mean 23.4 years). RESULTS: Auxiliary incisions for skeletal relaxation enabled symmetric remodeling and, in most cases, circumvented the need for a second pectus bar. The bars were left in position for a mean of 19.3 months (range: 12 to 35 months). There were no major complications. Minor complications such as pleural effusion, temporary pneumothorax, and mild recurrence of the deformity after bar removal were seen at rates similar to those for standard techniques. In the current study reporting outcomes of the previously described MOVARPE procedure, the authors saw no evidence of a possible disadvantage in the overall concept or execution of the procedure for the suggested indication. CONCLUSION: From this experience, we can state that, as an alternative to the MIRPE technique, MOVARPE is a method that offers high efficacy, particularly for rigid and complex pectus excavatum deformities at or beyond puberty.

A new technique for mixed-type pectus carinatum: modified Onen method.

We modified the Onen method for pectus carinatum repair and used a vertical incision instead of a transverse incision. The most important advantage gained by the vertical incision is that we can switch to the Ravitch method without needing an additional incision, by elongating the existing incision in patients in whom a pectus bar cannot be placed. We successfully performed the modified Onen technique in a 16-year-old boy with a mixed-type pectus carinatum deformity.

Clinical Study of Allogeneic Graft Reconstruction for Sternum Tumor.

OBJECTIVES: This paper aimed to study the feasibility, the surgical methodology, and technique for reconstruction using allogeneic sternal graft after sternum tumor resection. MATERIALS AND METHODS: Three patients (2 men and 1 woman, aged 19, 44, and 52) with primary sternum malignant tumor were admitted from January 2008 to December 2010 to the Second Hospital of Shandong University, Jinan, China. We conducted subtotal resection of the sternum and simultaneous reconstruction with allogeneic sternal graft. Allogeneic sternum was frozen beforehand; the scope of removal was 2 cm away from the lesion. Transplanted allogeneic sternum was fixed using steel wire and residual cavity was filled with the greater omentum. RESULTS: Three patients recovered without major complication and were discharged from the hospital with successful operation and satisfactory results. They were followed-up for 6 months to 2 years, no tumor relapse or any obvious rejection were found. CONCLUSIONS: The freezing allogeneic sternum can be used as a substitute for reconstruction after sternum tumor resection.

Distraction Osteogenesis of Multiple Ribs for the Treatment of Acquired Thoracic Dystrophy.

Acquired thoracic dystrophy is a complication associated with early open repair of pectus excavatum resulting from extensive cartilage resection. The condition can cause serious functional and physiologic impairments, including cardiac compression and restrictive pulmonary function. We describe a 17-year-old boy with acquired thoracic dystrophy after Ravitch repair of pectus excavatum during infancy, whom we treated with distraction osteogenesis. The patient had a marked deformity of the chest wall and general hypoplasia of the central portion of the ribcage, with resultant symptomatic dyspnea on exertion and reduced pulmonary function. After osteotomies and distraction osteogenesis of bilateral ribs 4-8 using customized distraction devices, he had improved thoracic contour, resolution of dyspnea, and decreased restrictive pulmonary symptoms. This case suggests that distraction osteogenesis, already used extensively in craniomaxillofacial and orthopedic surgery, may be a novel method for management of this condition.

Bilateral Subpectoral Interfascial Plane Catheters for Analgesia for Sternal Fractures: A Case Report.

OBJECTIVES: Sternal fractures occur after deceleration injuries such as falls and road traffic accidents. Recovery from isolated fractures is excellent, but mortality increases dramatically with concurrent chest injuries such as rib fractures and soft tissue injuries. Short-term complications include chest pain, which prevents patients from taking deep breaths and coughing, thereby predisposing them to chest infections. CASE REPORT: We present a case of a 73-year-old woman with sternal fracture in whom enteral analgesia was inadequate and who was intolerant to intravenous opiates. CONCLUSIONS: The patient was successfully treated with a continuous infusion of local anesthetic into the subpectoral interfascial plane. We also discuss the use and potential benefits of the subpectoral interfascial plane block in the treatment of pain from sternal fractures.

Sternal Segment Dislocation in a Child Treated by Conservative Observation.

Sternal segment dislocation is rare in children, with only eight cases appearing in the literature. Four of the six reports recommended surgical treatment such as excision or open reduction and fixation [1-4], while the remaining two reports recommended conservative observation. Therefore, it remains unclear whether surgical treatment is necessary. We report a case of sternal segment dislocation in a child. Although the segment had rotated 90°, it was remodeled. We now believe that surgical treatment is not necessary for this condition.