Recurrent Slipping Rib Syndrome: Initial Experience with Vertical Rib Stabilization Using Bioabsorbable Plating.

Background: Slipping rib syndrome (SRS) is an often underdiagnosed cause of lower chest wall and abdominal pain. The diagnosis of SRS is established by physical examination with or without dynamic ultrasound. The pain can be debilitating and surgical excision of the nonattached, subluxing cartilages is curative for most patients, but frustratingly, up to a quarter of patients have transient or limited relief and require reoperation. Some of these patients were found to have subluxation of the remaining bony ribs, suggesting that excision of rib cartilage alone may not be curative in a subset of patients. Materials and Methods: A retrospective review was performed of 3 patients with recurrent slipping rib pain and hypermobile bony ribs on reoperation. In an effort to stabilize the hypermobile ribs, vertical bioabsorbable plating across their ribs was performed. The plates secure the ribs apart from each other, preventing the movement of ribs against each other and therefore the pain. Results: All patients tolerated the procedure well. Mean length of stay was 2.6 days. Mean follow-up is 7 months and all report significant improvement in pain. Conclusions: Rib plating allows stabilization of hypermobile ribs, while preserving the patient's anatomical rib cage, and is a safe treatment for recurrent pain after the initial procedure. This is a novel approach in patients with recurrent slipping rib symptoms.

Effectiveness of Compressive External Bracing in Patients with Flexible Pectus Carinatum Deformity: A Review.

There has been a growing interest in the nonoperative treatment of chest wall deformities over the last few decades; with the advent of external compressive orthotics, similar outcomes have been reported compared with surgical intervention. There have been fewer major complications reported with dynamic compression bracing on the chest wall; however, the Achilles heel of this approach still lies with treatment tolerability and compliance. A Medline literature search was undertaken to evaluate the evidence concerning the techniques, modifications, and outcomes associated with external compressive bracing in the setting of pectus carinatum. Sixteen articles were integrated after literature review and data were collected on methods of assessing pectus carinatum (degree of severity as well as type), patient selection protocol (i.e., suitability for external compressive bracing), the bracing protocol itself, duration of treatment, metrics used to assess outcome, and success, compliance, and dropout rate, and length of long-term follow-up. Compressive external bracing appears to be a safe and well tolerated nonsurgical treatment option for young patients with flexible pectus carinatum deformities. However, there is still a need for robust level I randomized data from multiple centers with a clearly standardized bracing protocol, objective measurement of outcomes, and recording of results at the end of the bracing treatment program in sufficiently powered sample sizes over a significant follow-up period.

Analysis of Rib Cartilages Anomalies in Patients With Microtia.

OBJECTIVE: The objective of this study was to identify the characteristics and incidence of rib cartilages anomalies in patients with microtia and to investigate the interaction between microtia and rib cartilages anomalies. METHODS: A total of 214 consecutive patients received a preoperative 3-dimensional chest computed tomography. A retrospective study was performed with the clinical and imaging data from November 2014 to July 2015. Pearson X2 test and Spearman analysis were used to analyze the interaction between microtia and rib cartilages anomalies. RESULTS: With the 3-dimensional chest computed tomography images, a total of 62 patients (29.0%) were documented with rib cartilages anomalies including 4 patients (1.9%) with numerical variations, 13 patients (6.1%) with structural changes, and 51 patients (23.8%) with abnormal articulations. The incidence of rib anomalies (P = 0.035) varied with grades of microtia. CONCLUSIONS: The incidence of rib cartilages anomalies was high in patients with microtia. The authors observed a higher incidence of costal cartilages anomalies in patients with a more serious grade of microtia. Microtia with rib cartilages anomalies may involve a new syndrome previously undiscovered or just another extension with the very wide spectrum of microtia.

[The morphological and morphometric study of amianthoid transformation of the costal cartilage in health and in keeled chest deformity in children]. / Morfologicheskoe i morfometricheskoe issledovanie amiantoidnoi transformatsii rebernykh khryashchei v norme i pri kilevidnoi deformatsii grudnoi kletki u detei.

Amianthoid transformation (AT) is the accumulations of abnormal collagen structures (amianthoid fibers) in the hyaline cartilages, tumors, and tendons. Neither functional value of costal cartilage matrix AT, nor its role in the pathogenesis of congenital chest deformities is known now. AIM: to examine the morphological features of AT in the costal cartilage of children with the normal and keeled chest. SUBJECTS AND METHODS: Costal cartilages were studied in 6 children with the normal chest (autopsy material) and in 5 ones with keeled chest (surgical material). Tissue fragments were fixed in 10% neutral formalin and embedded in compacted paraffin. The sections were stained with hematoxylin and eosin, picrofuchsin by van Gieson, with picrosirius, toluidine blue and by the Malaurie method modified by Gallego. The specimens were examined by light, phase-contrast, dark-field, fluorescence, and polarization microscopy. The frequency of AT sites and their area were morphometrically studied and the findings were then statistically processed. RESULTS: Various types of AT in the costal cartilages were described as both the normal and keeled chest. According to their morphological features, classic, fine-fiber, twisted, and intralacunar types were identified. There were statistically significant increases in the incidence of all types (except the intralacunar one) and in the area of the fine-fiber AT type in keeled chest deformity as compared to health. There were positive correlations between the area of classic, intralacunar, and twisted types in both groups and between the area of a classic type and age in the controls. CONCLUSION: A classification of AT areas varying in structures in health and disease has been given for the first time; their relation to each other and to the presence of keeled deformity shown, which, in our opinion, suggests that AT is implicated in the pathogenesis of the disease.

[Supernumerary muscular masses of the anterior thoracic wall. Case report and review].

INTRODUCTION: On the anterior thoracic wall, some supernumerary muscular masses can be present, like the sternalis muscle, which is situated over the pectoralis major muscle fascia, deep to the subcutaneous tissue. Its fibers can be parallel or oblique to the sternum, and are clinically important due to the possibility that during certain radiologic procedures they can be confused with some types of breast pathologies. MATERIAL AND METHODS: Bibliographic review of supernumerary muscular masses of the anterior thoracic wall and case report in a colombian male cadaver of mixed ethnia, dissected by medical students at the Department of Morphology at the Universidad del Valle, in Cali, Colombia. RESULTS: In the right side of the anterior thoracic wall of the cadaver an anatomical variation of low occurrence in the general population, the sternalis muscle, was found. The muscle fibers had a vertical direction, parallel to the right sternal margin. Considering all the muscular fascicles, its dimensions were approximately 7,0 cms in length and 2,9cms in width. CONCLUSION: Having in mind the characteristics of the present anatomical variation, and that there can be some radiologic, surgical and clinical implications, it is important for the health professional to know the anatomy and epidemiology of the sternalis muscle.

Scoring of Deformed Costal Cartilages Reduces Postoperative Pain after Nuss Procedure for Pectus Excavatum.

OBJECTIVE: The present study aims to elucidate whether or not scoring deformed cartilages reduces postoperative pain after the Nuss procedure for pectus excavatum patients. METHODS: A total of 46 pectus excavatum patients for whom the Nuss procedure was conducted were included in the study. The patients were categorized into two groups, depending on whether or not the supplementary maneuver of scoring deformed cartilages was performed in addition to the Nuss procedure. Patients for whom deformed costal cartilages were scored were categorized as the Scoring Group (n = 24); those who received no such scoring were categorized as the Non-Scoring Group (n = 22). After evaluating the maximum stresses occurring on the thoraces by means of dynamic simulation using finite element analyses, intergroup comparison of the maximum von-Mises stress values was performed. Furthermore, after quantifying postoperative pain as the frequency with which patients injected anesthetics through an epidural pain-control system within 2 postoperative days, the degree of pain was compared between the two groups. RESULTS: The maximum stresses occurring on the thorax were significantly greater for the Non-Scoring Group than for the Scoring Group; injection frequency was also greater for the Non-Scoring Group (average 4.9 times for 2 days) than for the Scoring Group (average 2.5 times for 2 days). CONCLUSION: High stresses occur due to the performance of the Nuss procedure, causing postoperative pain. The stresses can be reduced by performing supplementary scoring on deformed cartilages. Accordingly, postoperative pain is reduced.