Novel Technique For High-tension Repair Of Complex Traumatic Sternal Fractures: Zip For A Fix
Katrina M Morgan1, Kathryn T Anderson2, *Barbara A Gaines2, *Stefan Scholz2
1UPMC, Pittsburgh, PA;2Children's Hospital of Pittsburgh, Pittsburgh, PA
A 10-year-old girl suffered seatbelt trauma from a high-speed motor vehicle collision resulting in severe injuries to her left neck and upper chest. We present a novel technique employed to repair multi-fragmented sternal fractures and severe anterior chest wall disruptions. Methods:The patient’s medical records were reviewed. A three-dimensional thoracic computed tomography angiography (CTA) was obtained; intraoperative and postoperative images and videos were analyzed.Findings:Admission thoracic CTA showed an occlusion of the left subclavian artery. The manubrium was fractured into 3 pieces with accompanying right 2nd and 3rd anterior rib fractures, resulting in a gap in the upper anterior chest wall with palpable lung herniation. The occluded left subclavian artery was successfully recanalized with an endovascular stent. Small bone fragments without adequate landing zones and her young age compromised the durability of sternal and rib plating alone. Therefore, the commercially available sternal cable-tie system, ZIPFIX®, was utilized. ZIPFIX® was tunneled between the right 1st rib and clavicle and around the sternum, left 2nd, and 3rd ribs (figure). Additionally, one rib and two sternal plates closely aligned the two manubrial pieces and the right 2nd rib to the sternum.
Conclusions (implications for practice):We present a novel technique to repair high-tension, complex manubrial and chest wall injuries utilizing a cable tie system, which can be employed in young patients without an adequate target for durable plating.
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