Biomaterials for Repair of Traumatic Costal Arch Injuries
Daniel L. Miller
WellStar Heath System/Mayo Clinic Care Network, Marietta, GA, USA.
OBJECTIVE: Injury to the costal arch, costal cartilages (CC) 7 through 10 is a challenge to manage. Open repair with internal fixation (ORIF) traditionally has been metal-based. Metal-based repair techniques for cartilagous injuries has been disappointing. Recently, we introduced biomaterials for ORIF of costal arch injuries.
METHODS: Retrospective review of patients who underwent ORIF of costal arch injuries from January 2015 to June 2018; 22 patients underwent repair using bioabsorbable polylactide (PLA) plates. Radiological evaluation included 3-D reconstruction CT Scan. Postoperative pain management was with liposomal bupivacaine.
RESULTS: Eighteen (81%) patients were men with median age of 45 years (20 - 79). Cause of injury was blunt trauma in 19 (MVA - 12, Fall - 4, MCA - 3) and spontaneous in 3. Twenty one (95%) injuries were right-sided. Three patients were ventilated at the time of ORIF; all were extubated within 48 hours. There were no operative deaths. Complications occurred in 5 (23%) patients. Hospitalization was a median of 5 days (3 - 14) after ORIF. Follow-up was a median of 22 months (5 - 36). One patient required reoperation for reinjury to the same costal arch and one patient underwent diaphragmatic plication after ORIF. Twenty one (95%) of the patients was pleased with the long-term results.
CONCLUSIONS: Traumatic costal arch injuries can be management successfully with a multimodality protocol including detailed radiological evaluation, bioabsorbable plate ORIF, thoracic cavity field block and pulmonary rehabilitation. Biomaterial ORIF allows for return of near-normal chest wall mechanics with limited morbidity and no mortality.
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