Fixation of Traumatic Sternal Fractures Using SternaLock Plating System.

A 43-year-old man experienced chest trauma due to a car accident. Compound sternal fractures with severe dislocation were seen on computed tomography of the chest. Using a SternaLock plating system with manual reduction, fixation of the sternal fracture was successfully performed. There were no complications related to the operation.

CASE REPORT

A 43-year-old man, impacted in his chest by a car accident, complained of severe chest pain in his anterior chest wall with palpable sternal instability. Computed tomography (CT) of the chest showed a displaced compound mid-body sternal fracture (Fig. 1). Troubled with fracture of several cervical bones accompanied by sternal fracture, he was scheduled for open sternal fixation 3 days after the trauma because of combined operation with spine surgery. Open reduction and internal fixation of the sternum was performed using the SternaLock system (Biomet Microfixation Inc., Jacksonville, FL, USA).

Fig. 1

(A) The preoperative computed tomography scan shows a displaced compound sternal fracture. (B) Intraoperative picture of a compound sternal fracture.

After a midline longitudinal incision over the sternum, the fracture site was carefully debrided of any fibrous union and old hematoma to expose healthy bone. Before plate fixation, manual reduction of the sternal fracture was assisted by the use of bone reduction forceps placed within the surrounding intercostal spaces. Three 4-holed straight plates were used vertically and horizontally due to compound sternal fracture (Fig. 2), manually contoured to the underlying sternum, and secured using self-drilling, self-tapping screws. The screw length was 10 mm, which was chosen by the thickness of the sternum (as measured on chest CT) at each point of screw placement. The wound was irrigated and closed. The patient was not discharged because he was receiving rehabilitation treatment for his leg, which had been paralyzed due to the cervical spine trauma. The 3-month follow-up demonstrated normal wound healing with no complaints of symptoms associated with instability. The repair was palpably stable and non-tender.

Fig. 2

(A) After the successful reduction, the sternum was rigidly fixed with three 4-holed SternaLock straight-plates. (B) A postoperative computed tomography scan shows reduction and rigid fixation of the fractured sternum.

DISCUSSION

Sternal fractures are common after severe chest wall trauma. More than 95% of sternal fractures are treated conservatively, and there are few reports on the late sequelae or evolution of such fractures [1,2].

Surgery is a viable option when severely displaced fractures of the sternum entail physical deformity and prolonged pain [2]. The rationale for surgical repair in our case was evident physical deformity associated with a relatively young age, uncontrolled pain, and combined surgery for cervical spine fractures.

Open reduction and stainless steel wiring has been the mainstay of treatment [3]. However, the advantage of this technique is only that it is less expensive than plating. This technique takes advantage of the non-rigid nature of the wires, and the potential for wire pull-through can result in secondary sternal fractures or sternal nonunion [3]. Moreover, this technique is barely suitable for compound sternal fractures, which are not stabilized by the non-rigid wire. More rigid fixation using a plate and screw system minimizes these risks [4]. In our case, the patient had a compound sternal fracture (Fig. 1). Sternal plating systems, such as the SternaLock system we used, incorporate a thinner cuttable section that spans the fracture line and can be easily divided using common wire cutters [5].

In contrast with other plating systems, the strongest point of SternaLock uses self-drilling and self-tapping screws, eliminating the need for drilling and reducing the chance of injury to mediastinal structures [5]. Therefore, SternaLock may enable more secure reductions.

In summary, we report the successful treatment of traumatic compound sternal fracture with open reduction and rigid internal fixation using the SternaLock plating system. We think this system is easier to use and safer than others.