초록접수 현황
| 14F-008 | 포스터 발표 |
Failed Sternal Closure Using a Cervical Plate System in Patient with Isolated Traumatic Sternal Fracture
김수완, 이석재, 장지원
제주대학교 의학전문대학원 흉부외과학교실
Background : Traumatic sternal fractures have become increasingly frequent and account for 3% to 8% of all blunt trauma. More than 95% of patients with isolated sternal fracture are treated conservatively and there are few reports on the late sequelae or evolution of such fractures. We performed a sternal fixation through the methods which were introduced by the report describing a technique of surgical repair for isolated traumatic sternal fracture using a system of titanium cervical plates currently employed in spine surgery.
Methods : A 66-year-old male presented a chest pain after traffic accident. Laboratory and chest X-ray findings revealed an isolated fracture on the upper sternal body (A). Although conservative therapy underwent for 11 days, the patient complained of intractable chest pain and limited motion of the arms. Surgery was performed in general anesthesia and the skin was incised in the midline. The plates were fixed in a parallel fashion on either side of the sternal midline bridging the fracture site and leaving adequate holes over bone for screw insertion (B). A postoperative chest X-ray showed an intact sternal configuration (C) and patient’s symptoms were resolved. However, a follow-up chest X-ray revealed a displacement of the sternal body and protruding sternal plate 17 days after the operation (D).
Results : We propose that there were a few surgical malpractices and errors. We suggest that 1) early surgical repair prevent adhesion surrounding the fracture site, 2) alignment between the upper and the lower fragment of the sternum should be pasted exactly, 3) sternal plates should be attached to the debrided sternal surface, 4) the screw requires full length near to penetrate the posterior wall of the sternum.
Conclusion : If more delicate surgical techniques were performed, cervical plate system seems to be an alternative option for isolated traumatic sternal fracture.
Methods : A 66-year-old male presented a chest pain after traffic accident. Laboratory and chest X-ray findings revealed an isolated fracture on the upper sternal body (A). Although conservative therapy underwent for 11 days, the patient complained of intractable chest pain and limited motion of the arms. Surgery was performed in general anesthesia and the skin was incised in the midline. The plates were fixed in a parallel fashion on either side of the sternal midline bridging the fracture site and leaving adequate holes over bone for screw insertion (B). A postoperative chest X-ray showed an intact sternal configuration (C) and patient’s symptoms were resolved. However, a follow-up chest X-ray revealed a displacement of the sternal body and protruding sternal plate 17 days after the operation (D).
Results : We propose that there were a few surgical malpractices and errors. We suggest that 1) early surgical repair prevent adhesion surrounding the fracture site, 2) alignment between the upper and the lower fragment of the sternum should be pasted exactly, 3) sternal plates should be attached to the debrided sternal surface, 4) the screw requires full length near to penetrate the posterior wall of the sternum.
Conclusion : If more delicate surgical techniques were performed, cervical plate system seems to be an alternative option for isolated traumatic sternal fracture.
책임저자: 이석재
제주대학교 의학전문대학원 흉부외과학교실
연락처 : 김수완, Tel: 064-753-8125 , E-mail : 95swan@gmail.com
