Three-dimensional modelling and printing in anterior chest wall reconstruction and stabilisation.

Anterior chest wall instability as a result of sternocostal non-union is a rare complication but can give rise to invalidating pain and cardiac arrhythmias. A woman in her 40s was referred to us with anterior chest wall pain and instability after a modified Ravitch procedure. Sternocostal pseudoarthrosis was seen for which multiple operations were performed which were complicated by low-grade infections. A patient-specific three-dimensional modelled and printed prostheses was used in an operation to both lift the sternum for pectus correction and to reconnect the sternum and the sternal costal junction to regain anterior chest wall stability.

Elastic Stable Chest Repair as a Means of Stabilizing the Anterior Chest Wall in Recurrent Pectus Excavatum with Sternocostal Pseudarthrosis: An Innovative Fixation Device.

INTRODUCTION: Open surgical procedures in the treatment of pectus excavatum (PE) involve predetermined incisions in the parasternal cartilage and the bony ribs. For some procedures, the ribs are even dissected from the sternum for better sternal mobilization and thus better elevation of the funnel. Secure restoration of the sternocostal junction is then required, with the consequence that healing may be quite impaired. Patients may also subsequently suffer from sternocostal nonunion, for example, pseudarthrosis, and dislocated ribs, as well as pain and a recurrence of PE. MATERIALS AND METHODS: Patients underwent another open surgery with revision of the pseudarthrotic sternocostal junctions and sufficient mobilization of the anterior chest wall, followed by an open reduction and internal fixation using Matrix Rib titanium plates (Synthes, Oberdorf, Switzerland). This procedure consisted of elevating the anterior chest wall and fixing the ribs to the sternum. In 2011 and 2012, we studied this procedure, known as elastic stable chest repair (ESCR), in a series of 20 patients. The patients underwent clinical and ultrasound examinations and X-ray radiographs after the operation, after 6 weeks, and at 3- and 12-month intervals. RESULTS: Follow-up showed high patient tolerance, although a loose plate was observed in one patient and a broken plate in three patients. A stable union was achieved for all sternocostal pseudarthroses. PE improved highly significantly (p < 0.001), as the Haller index decreased from 3.6 (range: 2.7-6.6, standard deviation [SD]: 0.92) to 2.7 (range: 2.0-3.7, SD: 0.42). Pain in the anterior chest wall was significantly reduced after the operation in the majority of cases. All but one patient was mobilized already the day after the operation. CONCLUSIONS: ESCR in recurrent PE achieved functional stabilization of the anterior chest wall combined with satisfactory results.

Sternocostal dislocation following open correction of pectus excavatum-"stairway phenomenon": complication management by means of sternocostal locking titanium plate osteosynthesis.

INTRODUCTION: Some open surgical methods describe complete sternocostal dissection with subsequent resynthesis. Lack of consolidation with painful sternocostal instability and retrosternal dislocation of sternal rib tips are possible complications. MATERIALS AND METHODS: Seven patients with symptomatic unilateral sternocostal dislocation were included in this study. After diagnosis, confirmed by three-dimensional computed tomography (CT), patients underwent open surgery. All affected ribs were reset and fixed to the sternum with the aid of titanium implants. RESULTS: The patients had, on average, unilateral dislocation of 3.4 rib joints with 15.4 mm retrosternal dislocation, which was fixed with 2.3 plates. A titanium splint was also employed. The recurrent nature of the problem made procedures very time-consuming (average operation time: 3 hours 25 minutes). One patient suffered strong intraoperative bleeding requiring transfusion of blood products and access enlargement. Follow-up examinations showed high patient satisfaction (grade of 1.7; rating scale 1-6). Remaining rib instabilities were observed just as infrequently as were material failures. The sternocostal rib splint in the costal cartilage became loose and was removed. One patient exhibited a pectoral muscle asymmetry. No other complications were observed. CONCLUSION: The term "stairway phenomenon" describes the dislocation of sternocostal joints. Observed after open pectus excavatum correction it can trigger substantial physical complaints. Thus, preserving those joints during pectus repair is strongly recommended. Locking titanium plates are a safe alternative to sternocostal suture fixation and is characterized by high patient satisfaction.

First sternocostal degenerative arthritis with intrarticular fluid collection. A case report.

A rare case with clinical condition of first sternocostal degenerative arthritis with intra-articular fluid collection that developed after long-lasting intense exercise (weight-lifting) for twenty years is reported. Imaging findings and differential diagnoses of the case are presented.

Simple technique to stabilize the costochondral junction using synthetic mesh after a thoracoabdominal incision.

We describe a technique to assist in the stabilization of the costochondral junction using a small strut of synthetic mesh in patients undergoing a thoracoabdominal incision.

Minitoracotomía paraesternal derecha para cirugía valvular mitral, aórtica y combinada / Parasternal righ minithoracotomy for mitral, aortic and combined valve surgery

Introducción: el abordaje convencional para la cirugía valvular es la esternotomía. Una alternativa para ofrecer el mismo tratamiento con menor morbilidad es la minitoracotomía paraesternal. Objetivo: presentar nuestra experiencia con este abordaje para cirugía valvular. Métodos. se trata de una serie de ocho pacientes intervenidos entre enero y mayo de 1997 con cirugía valvular mitral (cuatro casos), aórtica (tres) y combinada (uno), a través de una incisión paraesternal derecha de 10 centímetros con derivación cardiopulmonar. Resultados: los ocho procedimientos se efectuaron sin dificultades. El sangrado posoperatorio, la asistencia ventilatoria y la estancia hospitalaria fueron menores que los habituales para el abordaje por esternotomía; el tiempo quirúrgico fue similar. Hubo una defunción por hemólisis e hipercalemia refractaria. Conclusión: las cirugías valvular mitral, aórtica y mitroaórtica pueden ser realizadas a través de una minitoracotomía paraesternal; sus ventajas son menos morbilidad y recuperación más temprana de los pacientes

[Degenerative chondroarthropathy of the sternocostal joint following heart surgery]. / Degeneratív chondroarthropathia a sternocostalis ízületeken szívmütétek után.

Involvement of the sternocostal joints was investigated in a series of 46 males and 18 females following median sternotomy annually in a 5-year period and compared to 62 age- and sex matched control subjects after one year solely. Both groups had a mean age of 49.2 years. The degenerative chondroarthropathy of sternocostal joints was 1.69-times more frequent in heart operated upon patients as compared to control persons. Based on radiographic findings the degenerative chondroarthropathies were classed in 0 to 3 severity groups. Were seen articular space narrowing in 95.4%, osteophytes of the margin of the articular surface in 88%, subchondral bony eburnation in 79% and cystic radiolucencies in 48.9% of sternocostal joints on poststernotomy standard plain film tomograms. Not occurred intraarticular gas phenomenon and bony ankylosis. The development of arthropathies is traced back to mechanical stress-related predisposing factors and stressed the importance of oculoneutral dehiscences that simulated normal roentgenanatomic projections and caused a masked insufficiency in sternocostal junctions.

The "meat hook" or "dog chain" retractors: a simple method of costal margin and sternal elevation retraction.

A brief history of sternal elevation retractors is given, and the authors detail their own method of sternal elevation and costal margin retraction, showing it to be an inexpensive, and a much simpler, more effective, and more efficient system than any other in use at this time.

Clinical features of 22 cases with "inter-sterno-costo-clavicular ossification". A new rheumatic syndrome.

We present 22 cases with inter-sterno-costoclavicular ossification. Clinical and pathological findings show that abnormal ossification observed in this situation is due to non-suppurative chronic inflammation of the soft tissues around the sterno-costo-clavicular region such as the costo-clavicular ligament. We have classified X-ray findings into three stages according to the extent of the ossification; localized, generalized, and hyperostotic, and show that the disease progressed in this sequence. A considerable number of the patients showed abnormal X-ray findings in the spine or the sacro-iliac joint. Frequent association of pustulosis palmaris et plantaris was noted in this disease. Most of the cases were treated effectively with anti-inflammatory drugs, but a few cases required surgical resection of the ossified mass with the clavicle or the first rib in order to relieve the severe pain.