Clinical & Medical CASE REPORTS

Biography

Abstract

Background

 

Fixation of complex rib fractures and fractures associated with poor bone quality can pose a technically challenging operation.  We present a novel “plate on plate” technique to extend fixation across additional fractures encountered on a rib after an initial plate has already been placed and for ribs with multiple segmental fractures for a long distance without enough room to place separate plates. We have also used this technique to allow for extreme in-plane contouring when a single plate cannot be adequately contoured.

 

Case presentations

 

Our case report includes two 80-year-old females with medical history significant for osteoporosis who presented to the emergency room with multiple rib fractures including flail segments.  Each patient was taken to the operating room for surgical stabilization of their rib fractures after failure of non-operative management.  Many of the patients’ fractures were not visible on axial imaging due to poor bone quality or cartilaginous involvement.  Moreover, lower rib fractures involving the costal cartilages required extreme in-plane contouring beyond what we could achieve with a single plate with our available instrumentation. Both patients underwent a novel plate on plate technique to achieve extend fixation once an initial plate had been placed, for extremely long segments of rib with multiple segmental fractures as well as to achieve extreme in-plane contouring.

 

Conclusion

 

The plate on plate technique is a feasible way to obtain rib fracture stabilization in patients when additional fractures are encountered after initial plate placement as well as to address extreme in-plane contour challenges.