Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling

The overall goal of this procedure is to reduc and to fix a sternal fracture properly and safely to accomplish this first preoperative planning is achieved through performing a computed tomography scan to determine the type of fracture following preparation of the patient for the operations procedure. The approach to the sternal fracture is executed to reduc the fracture. The final step is to fix the fracture using locking plate osteons and limited depth drilling.

Transverse fractures and oblique fractures at the corpus stern eye are plated longitudinally, whereas oblique fractures of manubrium sternal costal separation and any longitudinally fracture needs to be stabilized by a transverse plate from rib to sternum to rib. Ultimately, the soft tissue and the wound are closed by sutures. Postoperative chest x-rays are performed to show the correct reduction of the fracture and the correct positioning of the implants.

The main advantage of this technique over existing methods like using non locking plates or even virus, is that a very stable asy synthesis is performed through a very safe procedure. We first had the idea for this method when we were thinking about a simple way to preserve from mediastinal injuries such as heart injuries. This can help answer key questions in the rheumatologic field, such as operative stabilization of the interior chest ball.

The implications of this technique extend toward therapy of unstable chest wall because fixing the sternal fracture is one of the key points in solving anterior flail chest injuries. So this method can provide insight into sternal osteotomies. It can also be applied to other systems such as pectus deformities.

Generally, individuals new to that method will not struggle because an atomic preparation is limited and easily to perform. Visual demonstration of this method is critical as the preoperative planning steps are difficult to learn because surgeons need to be very familiar to CT scan of anterior chest wall. Demonstrating the procedure will be Pascal Oppel, a postdoc from my laboratory To begin preoperative computed tomography, scan the chest wall for injuries.

Inspect the complete anterior chest wall, including examination of soft tissue, cartilage and bones. Look for bone fractures at the manubrium corpus stern eye and adjacent ribs, one to seven on both sides. Also look for cartilage disruption.

Be aware of cartilage disruption and sternocostal separation so as not to miss any cause of instability. Perform a three-dimensional evaluation. See the whole chest wall in the modus of three dimensional reconstructed pictures by evaluating each axial coronal and sagittal picture in detail.

Pinpoint the fracture by taking the distance from the upper sternal edge or jugular to the fracture. Use the sagittal view for measuring. See the text protocol for the case of measuring oblique fracture or multiple fractures.

Next, evaluate and measure the thickness of presternal soft tissue at the point of the fracture. Then estimate the length of the possible surgical incision performed in the midline. The operative procedure is performed on a postmortem human being to demonstrate each important step in different types of fractures with enough time to rule out the performance.

Once under anesthesia, place the patient in a supine position. Rest the arms on an arm board, which is placed less than 90 degrees to the midline of the body and level the board with the floor. This might be useful if insertion of a chest tube becomes necessary.

Remove superficial soil, debris, jewelry, and transient microbes before applying antiseptic agents. Leave hair at the surgical site in place Whenever possible, commence disinfection following the local standards. Start from the cleanest area, usually the operative and or incision site, and proceed in a concentric fashion to the least clean area.

Allow the disinfectant solution to dry completely naturally, ensuring that the antiseptic solution remains in contact with the skin for the required period of time. Secure free access to the jugular, the umbilicus, and the axillary midline on both sides. Use a sterile pen to mark anatomical landmarks such as sternoclavicular joints on both sides.

The upper sternal edge at the jugular, the lower sternal edge and xiphoid the seventh rib bilaterally, and the umbilicus. Draw the midline now between the jugular and umbilicus and mark the cranial and coddle edge of the fractures. Add half of the basic approach cranial and the other half coddle to the edges of the fractured region of the sternum.

Double check the correct position of the fracture and of the midline. Then perform the midline incision, respecting the anatomical layers in soft tissue. Remove the presternal hematoma by a vertical incision along the length of the hematoma and wash out as much as possible with 0.9%saline.Cautiously.

Take away the pectoral muscle bilaterally, beginning from the midline to the margin of the sternum whilst respecting the anatomical layers. Be aware of bleeding from smaller vessels and stop them. Then identify the fracture.

Next, expose the intercostal margin of the sternum, both cranial and coddle of the fracture. Perform an incision of the sternal periosteum longitudinally along the front edge of the sternum. Cautiously dissect the periosteum from the bone laterally and on the posterior surface of the sternum.

Using an eory or respiratory device, expose the fracture and clear the fracture cautiously. Usually retrosternal hematoma will appear at this time, wash out as much as possible with 0.9%saline. Measure the thickness of the sternum with a blunt instrument.

Do not use a common lot due to possible retrosternal injuries. Prepare a drilling machine with a drill of the length of sternal thickness or shorter, if not clear. Reduce the bone fragments by elevating the posteriorly depressed fragments with an elevator device, which can be inserted through the subperiosteal approach for transverse fractures and oblique fractures of the sternal body.

Mark the midline of the sternum using a pen or electrocautery. Following the initial surgical procedures, insert a small pointed ball forceps to the posterior surface of the sternum using the intercostal space next to the fracture, keeping very close to the sternal bone. Use the intercostal space of the depressed fragment first.

Then place a longitudinal plate next to the midline and fix it with the pointed ball forceps. To fix the plate with locked screws. Drill each hole using a drilling guide and the same drill as before.

Thus ensuring depth, limited drilling, and a secured locked fixation of each screw to the plate. Fix each main fragment with at least three screws following placement of the first plate. Place a second plate on the other side of the midline and repeat these steps.

Assemble the laterally dislocated fragment. B lateral compression using a pointed ball forceps, weller clamp or compression wires if necessary. For oblique fractures of manubrium, sternal causal separation and any longitudinal fractures.

Insert one small pointed ball forceps to the posterior surface of the sternum on each side using the intercostal space next to the fracture. Following initial surgical procedures, put a transverse plate from rib to rib, bridging the sternum with its fragments, and fix it with the pointed ball forceps. Then place at least three screw holes laterally of each fracture.

Fix the plate with locked screws. Use a drilling guide and the same drill, thus ensuring depth limited drilling. Again, fix each of the main fragments with at least three screws for osteos antithesis of each injured level.

Repeat these demonstrated steps. Next, double check the correct position of all plates and examine the anterior chest wall for sufficient stability. Proceed to look for any bleeding and stop it.

Also, rule out pleural lesions. Insert a subcutaneous drainage if necessary, placing the tube in front of the sternum and percutaneously divert about five centimeters away from the lower edge of the wound. Then close the wound.

Respecting the anatomical layers. Suture the periosteal incisions to preserve sternal blood supply. Approximation of the pectoral muscle to the midline is recommended to ensure a proper coverage of the implants with soft tissue.

As a final step following surgical treatment, take a chest x-ray to rule out pneumothorax and hemothorax. The additional lateral view will show the position of the sternal fragments and of the implants. The preoperatively performed computed tomography provides a detailed survey of the whole sternum and the adjacent ribs.

Axial pictures show injuries to cartilage in the soft tissue window and disruption of the sternocostal joints. Furthermore, the axial view shows longitudinal and oblique fractures of the sternum, whereas transverse fractures are rarely detected in this plane. Coronal reconstructed pictures describe the fractures direction from a similar point of view to the one.

During surgical treatment, the dislocation of the fragments in relationship to the midline can be described properly. The sagittal view shows the dislocation of fragments in the anterior posterior direction, a possible disruption of angular stern eye. The synchondrosis between manubrium and corpus stern eye is shown best in this plane.

The volume rendering technique gives an overview over the entire anterior chest wall showing rib fractures, manubrium and corpus stern eye fracture postoperatively taken chest x-rays in two planes show the correct reduction of the fracture and the correct positioning of the implants, which were administered. The fixation of each fragment using at least three screws usually shows a proper stabilization for transverse as well as for oblique and longitudinal fractures. Once mastered, this technique can be done in less than 30 minutes if it is performed properly.

While attempting this procedure, it's important to remember to have precise preoperative planning and use depth limited drilling Following this procedure. Other methods like fixation of stern osteotomy can be performed in order to answer additional questions like correction of pectus deformities After its development. This technique paved the way for researchers in the field of trauma surgeons to explore stabilizing unstable external injuries infl chest.

Now, after watching that video, you should have a good understanding of how to perform the approach and osteos synthesis of a fracture.