Skip to main content

Main menu

  • Latest content
    • Latest content
  • Archive
  • About the journal
    • About the journal
    • Editorial board
    • Information for authors
    • FAQs
    • Thank you to our reviewers
    • The American Association for the Surgery of Trauma
  • Submit a paper
    • Online submission site
    • Information for authors
  • Email alerts
    • Email alerts
  • Help
    • Contact us
    • Feedback form
    • Reprints
    • Permissions
    • Advertising
  • BMJ Journals

User menu

  • Login

Search

  • Advanced search
  • BMJ Journals
  • Login
  • Facebook
  • Twitter
TSACO

Advanced Search

  • Latest content
    • Latest content
  • Archive
  • About the journal
    • About the journal
    • Editorial board
    • Information for authors
    • FAQs
    • Thank you to our reviewers
    • The American Association for the Surgery of Trauma
  • Submit a paper
    • Online submission site
    • Information for authors
  • Email alerts
    • Email alerts
  • Help
    • Contact us
    • Feedback form
    • Reprints
    • Permissions
    • Advertising
Open Access

Novel repair of costal margin rupture with preoperative 3D planning

Casey T Walk, Gregory R Semon
DOI: 10.1136/tsaco-2022-001001 Published 29 September 2022
Casey T Walk
Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Casey T Walk
Gregory R Semon
Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF
Loading

What would you do?

This is a 32-year-old man involved in a motor vehicle crash in 2019 with chronic left-sided rib pain since. He was initially treated with physical therapy and medical management with no improvement. CT imaging in 2021 noted displaced left lateral seventh and eighth ribs, noted chest wall deformity, and when three-dimensional (3D) reconstruction of his ribs was created, this noted a left-sided costal margin rupture at the sixth and seventh ribs (figure 1).

Figure 1
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1

Preoperative 3D reconstruction CT imaging with circled costal margin rupture causing chest wall deformity. A- Sagittal view. B- Coronal view.

What we did and why

Due to this patient’s ongoing pain limiting his lifestyle, we opted to attempt a novel surgical intervention. The 3D printing of his ribs was created, and a custom rib plate, a sternal T plate 2mm thick, was molded preoperatively to the contour of his ribs as they had become deformed since the accident (figure 2).

Figure 2
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 2

Preoperative planning 3D printed chest wall to pre-mold rib plate.

He was brought to the operating room and an incision was made over his left anterior seventh rib, and the costal margin rupture was exposed along with the appropriate amount of space on the lateral rib for placement of the plate. The custom molded plate was brought to the field and fit into place, secured with sternal screws, and inspected to be in adequate position (figure 3). The chest wall felt intact with improvement in deformity and strength. The patient had no complications and was discharged home on postoperative day 1. He was followed up 2 weeks postoperatively with resolution of his chronic pain and was well healed. Informed consent was waived by the Institutional Review Board but discussed with the patient during his postoperative visits, and he agreed with the publication.

Figure 3
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 3

Intraoperative imaging. A- Exposure prior to rib plating. B- Completed rib plating with pre-molded rib plate secured into place noting to traverse the costal margin rupture with T portion secured on costal margin.

Rib plating for acute rib fractures is well researched and practiced in the trauma setting for specific indications, although the research on costal margin rupture is limited. This is a presentation of a successful costal margin rupture repair managed via custom rib plating using preoperative 3D planning. This has been shown to be an effective and safe approach to surgical management of costal margin rupture and should be considered in the future in appropriate patients.

In conclusion, this novel approach to repair costal margin rupture was successful and has demonstrated feasibility. We recommend offering this repair option on a case-by-case basis as there is limited research.

Ethics statements

Patient consent for publication

Not required.

Footnotes

  • Contributors CTW—article preparation, writing and editing. GRS—conception, article editing and final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

PreviousNext
Back to top
Email

Thank you for your interest in spreading the word on TSACO.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Novel repair of costal margin rupture with preoperative 3D planning
(Your Name) has sent you a message from TSACO
(Your Name) thought you would like to see the TSACO web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Print
Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Novel repair of costal margin rupture with preoperative 3D planning
Casey T Walk, Gregory R Semon
Trauma Surg Acute Care Open Sep 2022, 7 (1) e001001; DOI: 10.1136/tsaco-2022-001001

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Cite This
  • APA
  • Chicago
  • Endnote
  • MLA
Loading
Novel repair of costal margin rupture with preoperative 3D planning
Casey T Walk, Gregory R Semon
Trauma Surg Acute Care Open Sep 2022, 7 (1) e001001; DOI: 10.1136/tsaco-2022-001001
Download PDF

Share
Novel repair of costal margin rupture with preoperative 3D planning
Casey T Walk, Gregory R Semon
Trauma Surgery & Acute Care Open Sep 2022, 7 (1) e001001; DOI: 10.1136/tsaco-2022-001001
Reddit logo Twitter logo Facebook logo Mendeley logo
Respond to this article
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Article
    • What would you do?
    • What we did and why
    • Ethics statements
    • Footnotes
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • Dermal fenestration ‘pie crust’ technique for difficult fasciotomy closures
  • Surgical fixation of a traumatic fracture through a congenitally anomalous sternum: a case report
  • Severe blunt trauma to the transplanted kidney
Show more Challenges in trauma and acute care surgery

Similar Articles

 
 

CONTENT

  • Latest content
  • Archive
  • eLetters
  • Sign up for email alerts
  • RSS

JOURNAL

  • About the journal
  • Editorial board
  • Thank you to our reviewers
  • The American Association for the Surgery of Trauma

AUTHORS

  • Information for authors
  • Submit a paper
  • Track your article
  • Open Access at BMJ

HELP

  • Contact us
  • Reprints
  • Permissions
  • Advertising
  • Feedback form

©Copyright 2023 The American Association for the Surgery of Trauma