Early Surgical Reconstruction of Sternum with Longitudinal Rigid Polymer Plating after Acute Chest Trauma.

PURPOSE: The surgical management of the patients with traumatic sternal fractures remains controversial. The aim of this study was to evaluate the effectiveness of an early surgical reconstruction of a displaced sternal fracture utilizing longitudinal rigid polymer fixation in the settings of an acute chest trauma. METHODS: To perform the sternal fixation, we utilized a longitudinal rigid plating system. The plate is made of polyether ether ketone (PEEK), an organic thermoplastic polymer. RESULTS: We used the entire length of the plate on each side of the fracture, secured in multiple places with 6-8 screws. Once the plates have been fully secured we tighten all the screws with a screwdriver. We demonstrated that the method minimizes pain and prevents the development of pulmonary complications. CONCLUSION: This technique provides cosmetically acceptable results, minimizing risk of sternal nonunion, and decreases length of hospitalization.

Endovascular exclusion of mycotic aortic aneurysm.

The presence of prohibitive risk may preclude usual surgical management. Such was the case for a critically ill, 60-year-old woman who presented with concomitant, life-threatening conditions. The patient presented with acute central cord syndrome and lower-extremity paraplegia after completing a 6-week course of intravenous antibiotics for methicillin-sensitive Staphylococcus aureus bacteremia and osteomyelitis of the thoracic spine. Radiologic examination revealed bony destruction of thoracic vertebrae T4 through T6, impingement on the spinal cord and canal by an inflammatory mass, and a separate 2.5-cm mycotic aneurysm of the infrarenal aorta. The clinical and radiologic findings warranted immediate decompression and stabilization of the spinal cord, aneurysmectomy, and vascular reconstruction. However, the severely debilitated patient could not tolerate 2 simultaneous open procedures. She underwent emergent endovascular exclusion of the mycotic aneurysm with a stent-graft, followed immediately by laminectomy and stabilization of the thoracic spine. Intraoperative microbiology specimens showed no growth. The patient was maintained on prophylactic antibiotic therapy for 6 months. Fourteen months postoperatively, her neurologic function was near full recovery, and neither surveillance blood cultures nor radiologic examinations showed a recurrence of infection or aneurysm. Although the long-term outcome of endovascular stent-grafts in the treatment of culture-negative mycotic aneurysms is unknown, the use of these grafts in severely debilitated patients can reduce operative risk and enable recovery in the short term.

Arteriopathy in the high-performance athlete.

Pain occurs frequently in high-performance athletes and is most often due to musculoskeletal injury or strain. However, athletes who participate in sports that require highly frequent, repetitive limb motion can also experience pain from an underlying arteriopathy, which causes exercise-induced ischemia. We reviewed the clinical records and follow-up care of 3 high-performance athletes (mean age, 29.3 yr; range, 16-47 yr) who were admitted consecutively to our institution from January 2002 through May 2003, each with a diagnosis of limb ischemia due to arteriopathy. The study group comprised 3 males: 2 active in competitive baseball (ages, 16 and 19 yr) and a cyclist (age, 47 yr). Provocative testing and radiologic evaluation established the diagnoses. Treatment goals included targeted resection of compressive structures, arterial reconstruction to eliminate stenosis and possible emboli, and improvement of distal perfusion. Our successful reconstructive techniques included thoracic outlet decompression and interpositional bypass of the subclavian artery in the 16-year-old patient, pectoralis muscle and tendon decompression to relieve compression of the axillary artery in the 19-year-old, and patch angioplasty for endofibrosis affecting the external iliac artery in the 47-year-old. Each patient was asymptomatic on follow-up and had resumed participation in competitive athletics. The recognition and anatomic definition of an arteriopathy that produces exercise-induced ischemia enables the application of precise therapy that can produce a symptom-free outcome and the ability to resume competitive athletics.