• Alumina
• Carbon fiber-reinforced PEEK
• Chest implants
• Chest wall reconstruction
• PE
• PEEK
• Zirconia

• Finite Element Analysis
• Prostheses and Implants
• Ceramics/chemistry
• Thoracic Wall/surgery
• Humans
• Polymers/chemistry
• Ketones/chemistry
• Plastic Surgery Procedures/methods
• Biocompatible Materials/chemistry
• Materials Testing
• Ribs/surgery
• Benzophenones
• Stress, Mechanical
• Polyethylene Glycols/chemistry
• Zirconium/chemistry
• Titanium/chemistry
• Aluminum Oxide/chemistry
• Tensile Strength
• Polyethylene/chemistry
• Compressive Strength

• Helwan University

• Sternum
• reconstruction
• resection

Corrective osteotomy of a malunited distal radius conventionally relies on 2D imaging techniques for alignment planning and evaluation. However, this approach results in suboptimal bone repositioning, which is associated with poor patient outcomes. In this case series, we evaluate the use of novel patient-specific plates (PSPs), which feature navigation and fixation of bone segments as preoperatively planned in 3D.

Ten participants with distal radius malunion underwent CT scans for preoperative alignment planning. Patient-specific guides and plates were designed, 3D-printed, and sterilized for use in corrective surgery of the distal radius. Pre- and postoperative results were compared in regard to clinical, functional, and radiographic outcomes.

The application of a PSP was successful in 7 of the 10 cases. After treatment, the residual alignment error was reduced by approximately 50% compared with conventional treatment. The use of PSPs reduced pain significantly. Pre- and postoperative results were pooled and demonstrated significant correlations between: (1) pain and malpositioning, (2) the range of pro- and supination motion, the MHOQ score, the EQ-5D-5L score and dorsovolar angulation, and (3) MHOQ score and proximodistal translation.

The correlation between malalignment and MHOQ score, EQ-5D-5L score, pain, and range of motion shows that alignment should be restored as well as possible. Compared to the conventional approach, which relies on 2D imaging techniques, corrective osteotomy based on 3D preoperative planning and intraoperative fixation with a PSP has been shown to improve bone alignment and reduce pain.

IV.

• 3D planning
• Computer-assisted surgery
• Corrective osteotomy
• Custom treatment
• Malunion

Sternal fractures are rare accounting for about 3–8% of traumatic chest. There are many lines of treatments for sternal fractures which can be classified as conservative or surgical. Surgical techniques include wire fixation and sternal plating. There are no standardization of indications for each line of management.

We explore if sternal reconstruction using locking titanium plates and self-tapping screws provide the patient with the best chance of proper sternal healing avoiding chronic pain and its complications and allow the patient early mobilization and rapid restoring of his normal life at its maximum.

Our inclusion criteria are patients of both gender from 20 to 60 years of age presented with traumatic sternal fracture at any site or pathological fracture due to metastatic or primary tumors infiltrating the sternum. High Associated Injury Scale scores were excluded. Exclusion criteria also included patients younger than 20 years or older than 60 years. Primary outcome is post-operative pain score and is measured using numerical pain scale ranging from zero to 10 where zero means there is no pain at all and ten is the worst imaginable pain ever.

Sternal reconstruction using titanium plates has proven to be an efficient method of stabilization with tremendous immediate relief of pain showed by the differences between pre-operative and post-operative pain scale scores in our patients (n = 5) with Median scores being 7 and 1.5 with range being from 7 to 9 and 1 to 3 respectively (p-value = .039). Operative time range between 150 min and 90 min with median of 120 min. Extubation of patients was smooth with no events with median time of extubation being 120 min. From our experience, there were no observed wound complications except at the third patient who suffered a small wound hematoma that was resolved by gentle compressing only and needed no further intervention.

We recommend adopting sternal reconstruction using titanium plating systems more readily encouraging even larger clinical trials on the way to a clear guidelines. Plating systems show promising results with least pain, better stability, less complications and rapid, smooth recovery.

NCT04092374

• Fracture
• Pain
• Plates
• Reconstruction
• Screws
• Sternum
• Titanium

Sternal rigid plate fixation (RPF) has been adopted in recent years in high-risk cases to reduce complications associated with steel wire cerclage, the traditional approach to sternal closure. While sternal RPF has been associated with lower complication rates than wire cerclage, it has its own complication profile that requires evaluation, necessitating a critical examination from a national perspective. This study will report the outcomes and associated risk factors of sternal RPF using a national database.

Patients undergoing sternal RPF from 2005 to 2016 in the American College of Surgeons-National Surgical Quality Improvement Program were identified. Demographics, perioperative information, and complication rates were reviewed. Logistic regression analysis was performed to identify risk factors for postoperative complications.

There were 381 patient cases of RPF identified. The most common complications included bleeding (28.9%), mechanical ventilation >48 hours (16.5%), and reoperation/readmission (15.2%). Top risk factors for complications included dyspnea (odds ratio [OR], 2.672; P<0.001), nonelective procedure (OR, 2.164; P=0.010), congestive heart failure (OR, 2.152; P=0.048), open wound (OR, 1.977; P=0.024), and operating time (OR, 1.005; P<0.001).

Sternal RPF is associated with increased rates of three primary complications: blood loss requiring transfusion, ventilation >48 hours, and reoperation/readmission, each of which affected over 15% of the study population. Smokers remain at an increased risk for surgical site infection and sternal dehiscence despite RPF’s purported benefit to minimize these outcomes. Complications of primary versus delayed sternal RPF are roughly equivalent, but individual patients may perform better with one versus the other based on identified risk factors.

• Bone plates
• Sternum
• Surgery
• Treatment outcome
• Wound healing

• Diaphyseal defect
• Intercalary endoprosthesis
• Reconstruction
• Surgical technique

To investigate the methods and clinical efficacy of reconstruction of chest defects with titanium sternal fixation system after the surgical resection of sternal tumors.

A total of 6 patients with sternal tumor who were diagnosed and underwent resection and repair of the chest wall defects by titanium plates system, from 2017.3 to 2017.11 in our hospital were reviewed. Their pathological types, surgical reconstruction methods, follow-up results were analyzed.

Six cases of sternal tumor were completely resected and the sternums were reconstructed with titanium sternal fixation system. There was no operative death, postoperative chest wall deformity, abnormal breathing or complications of respiratory circulation. After 3 to 10 months of follow-up, there was no loose screw or plate exposure. Not only the thoracic appearances were good, but patients’ satisfaction was high.

Surgical resection is the best treatment for sternal tumors, no matter it is benign or malignant. Titanium sternal fixation system combine with other soft materials can reconstruct the chest wall well after resection, and this technique is efficient as well as easy to learn.

• Reconstruction of the chest wall
• Sternal tumor
• Titanium sternal fixation system

• 3D printing
• Computer modeling
• Thoracic surgery

• Chest wall
• reconstruction
• soft tissue sarcoma

Primary malignant or metastatic sternal tumors are uncommon. A subtotal or total sternectomy can offer a radical form of treatment. The issue is to restore the structural integrity of the chest wall.

We report the implantation of an individualized 3D–printed titanium sternum in a patient with a sternal tumor.

We believe that tridimensional print technologies may also change the strategy of chest wall reconstruction.

• 3D–printed titanium sternum
• Sternal tumor
• Sternectomy

Sternal metastases are not studied extensively in the literature. There is a paucity of information on their role in metastatic disease. The concept of the fourth column was described by Berg in 1993, and has been proven in case report, clinically and biomechanical studies. The role of the sternum as a support to the thoracic spine is well documented in the trauma patients, but not much is known about its role in cancer patients. This review examines what is known on the role of the fourth column. Following this we have identified two likely scenarios that sternal metastases may impact management: (1) sternal pathological fracture increases the mobility of the semi-rigid thorax with the loss of the biomechanical support of the sternum-rib-thoracic spine complex; and (2) a sternal metastasis increases the risk of fracture, and while being medical treated the thoracic spine should be monitored for acute kyphosis and neurological injury secondarily to the insufficiency of the fourth column.

• Fourth column
• Sternal fracture
• Sternal metastasis
• Sternal-rib-thoracic spine complex
• Spine stability

• Bisphosphonates
• Bone metastases
• Breast cancer
• Palliative radiotherapy
• Pathogenesis
• RANK ligand

• Bone Marrow/pathology
• Bone Neoplasms/mortality
• Bone Neoplasms/secondary
• Bone Neoplasms/therapy
• Breast Neoplasms/pathology
• Diphosphonates/therapeutic use
• Female
• Fluorodeoxyglucose F18
• Humans
• Positron-Emission Tomography
• Prognosis
• RANK Ligand/antagonists & inhibitors
• RANK Ligand/physiology

• Allogeneic bone graft of sternum
• Deep sternal wound infection
• Massive post-sternotomy defect
• Sternotomy