Cardiovascular and Thoracic Surgery

Rib and Sternum Repair

Sternal platingAlthough some fractures of the rib and/or sternum are treated with pain management and bracing, as well as endotracheal intubation and mechanical ventilation if necessary, some patients could benefit from surgical stabilization (osteosynthesis).

Potential benefits of surgical stabilization of fractures include reduced duration of mechanical ventilation support, shortened ICU stays and hospitalization, better secretion management through efficient cough, and minimized chest wall deformities resulting from trauma.

In patricular, repair to the sternum may become necessary in patients who have undergone open chest surgery (sternotomy). The midline sternotomy is the incision most commonly used in cardiac surgery and it is often denoted as the "cracking the chest". That in part is due to the fact that the sternum or the breast bone needs to be split down the middle to allow access to the heart. After surgery, the bone then needs to be closed and typically, this gets done by using wire to wrap or circle the halves of the sternum together. However, the fundamental principle that underscores all bone healing is rigid fixation, which is best achieved by plates and screws. These procedures can be performed in a minimally invasive manner, helping to speed recovery time and reduce infection.

Click to view: Sternal closure with titanium plate fixationA plate and screw closure of the sternum is particularly useful for high-risk patients, who are defined as high risk if there is an increased risk of the sternum not healing with "conventional" wire closure. The risk profile increases if the patient is diabetic, has COPD, is overweight, is undergoing repeat cardiac surgery, is taking steroid medication, has underlying osteoporosis, is likely to have a prolonged procedure, or requires bilateral internal mammary artery grafts, etc.

A study by the Department of Surgery, Section of Plastic Surgery, University of Chicago suggests that sternal plating helps to reduce complications, infections and helps speed recovery time.