Ipsilateral Rib Research Articles

Complications of Intercostal Nerve Transfer for Brachial Plexus Reconstruction

Although numerous publications discuss outcomes of intercostal nerve transfer for brachial plexus injury, few publications have addressed factors associated with intercostal nerve viability or the impact perioperative nerve transfer complications have on postoperative nerve function. The purposes of this study were to report the results of perioperative intercostal nerve transfer complications and to determine whether chest wall trauma is associated with damaged or nonviable intercostal nerves. All patients who underwent intercostal nerve transfer as part of a brachial plexus reconstruction procedure as a result of injury were identified. A total of 459 nerves in 153 patients were transferred between 1989 and 2007. Most nerves were transferred for use in biceps innervation, free-functioning gracilis muscle innervation, or a combination of the two. Patient demographics, trauma mechanism, associated injuries, intraoperative nerve viability, and perioperative complications were reviewed. Complications occurred in 23 of 153 patients. The most common complication was pleural tear during nerve elevation, occurring in 14 of 153 patients. Superficial wound infection occurred in 3 patients, whereas symptomatic pleural effusion, acute respiratory distress syndrome, and seroma formation each occurred in 2 patients. The rate of complications increased with the number of intercostal nerves transferred. Nerves were harvested from previously fractured rib levels in 50 patients. Rib fractures were not associated with an increased risk of overall complications but were associated with an increased risk of lack of nerve viability. In patients with rib fractures, intraoperative nerve stimulation revealed 148 of 161 nerves to be functional; these were subsequently transferred. In patients with preoperative ipsilateral phrenic nerve palsy, the risk of increased complications was marginally significant. Brachial plexus reconstruction using intercostal nerves can be challenging, especially if there is antecedent chest wall trauma. Complications were associated with increasing numbers of intercostal nerves transferred. Ipsilateral rib fracture was adversely associated with intercostal nerve viability; it was not significantly associated with complication risk and should not be considered a contraindication to transfer. Preoperative phrenic nerve palsy was marginally associated with the likelihood of complications but not postoperative respiratory dysfunction when associated with intercostal nerve transfer. Therapeutic IV.

Computed Tomographic Validation of the Porcine Model for Thoracic Scoliosis

Computed Tomographic Analysis of the Porcine Scoliosis Model. To describe the spinal and rib cage modifications using computed tomography (CT). Optimal development of nonfusion techniques for treatment of adolescent idiopathic scoliosis (AIS) requires a reliable large animal model that achieves spinal and rib cage modifications similar to AIS. Previous work has described the global 3-dimensional nature of the progressive deformity. This IACUC-approved study includes 11 extracted scoliotic spines from a previous investigation. Scoliosis was induced through unilateral posterior ligament tethering of the spine via pedicle screw fixation, and ipsilateral rib cage tethering. CT analysis was used to quantify rib cage asymmetry, axial rotation, and wedging of the apical functional unit (2 vertebrae and intervening disc) for each specimen. The mean coronal Cobb angle was 55.7 degrees (n = 11). Vertebral and intervertebral heights of the apical functional unit demonstrated convex heights (untethered) were always larger than concave (tethered) heights (P < 0.05). Axial rotation was maximal (mean, 20 degrees ) at 1 to 2 levels distal to the coronal apex. Maximal rib cage asymmetry was demonstrated at the transverse apex with significant coupling of the rotational and rib cage modifications (r = 0.82). A large initial Cobb index (tether tension) was significantly correlated with vertebral and intervertebral wedging and coronal curve progression. The present study has used CT analysis to analyze spinal and rib cage modifications in the Porcine Scoliosis Model. Placement of a unilateral ligamentous spinal tether combined with concave rib cage ligament tethering during the rapid growth stage of the Yorkshire pig results in significant apical vertebral and intervertebral wedging and rotational and rib cage modifications. The porcine model is a reliable and duplicable model for scoliosis, which bears significant similarities to AIS.

Unusual segmental fracture of the clavicle associated with rib fractures and pneumothorax

Segmental fracture of the clavicle is an extremely rare injury with only 4 cases being previously published in the English literature. We report an unusual case of a segmental clavicle fracture associated with ipsilateral rib fractures and pneumothorax. The available literature is also reviewed and the management of these injuries is discussed.

Prediction of Chest Wall Toxicity after Lung Stereotactic Body Radiotherapy (SBRT)

Prediction of Chest Wall Toxicity after Lung Stereotactic Body Radiotherapy (SBRT)

Surgical Management of Multiple Painful Rib Nonunions in Patient With a History of Severe Shoulder Girdle Trauma: A Case Report and Literature Review

The authors report painful nonunions after multiple rib fractures in a 50-year-old man who sustained a displaced scapula fracture and multiple ipsilateral rib fractures. The rib nonunions were reconstructed after an 11-month trial of nonoperative management, which was unsuccessful. The nonunions healed and symptoms completely resolved.

A Porcine Model for Progressive Thoracic Scoliosis

An IACUC-approved study to create a scoliotic deformity representative of adolescent idiopathic scoliosis. The goal of this study was to develop a reliable porcine scoliosis model and to evaluate the three-dimensional progression of the deformity. Optimal development of nonfusion techniques for treatment of adolescent idiopathic scoliosis requires a reliable large animal model that achieves a progressive three-dimensional (frontal, sagittal, axial) deformity. Limitations in previous work have led our team to the development of a porcine model. This IACUC-approved study included 18 Yorkshire pigs, obtained at 11 weeks old. Scoliosis was induced through unilateral posterior ligament tethering of the spine via pedicle screw fixation, and ipsilateral ribcage tethering. Progressive deformity was documented with biweekly radiographs. Frontal, sagittal, and axial modifications were assessed using the Cobb method. Animals were observed until severe deformity (>50 degrees) developed, then killed. Animals were observed for a mean 11 weeks. The mean coronal Cobb angle was 25 degrees immediately postoperatively and 55 degrees at 11 weeks. The mean lordosis increased from 4 degrees postoperative to 24 degrees at final follow-up. Apical axial rotation (posterior elements into concavity) increased from 4% postoperative to 27% at 11 weeks. Rate of coronal curve progression was significantly correlated with the initial Cobb index. This study establishes a porcine scoliosis model. With placement of a unilateral ligamentous spinal tether combined with concave ribcage ligament tethering a three-dimensional (frontal, sagittal, and axial) spinal deformity can be obtained. The speed of the progressive deformity leaves significant remaining skeletal growth to assess growth modulating therapies for correction. This work forms the basis for a number of investigative efforts at developing new fusionless therapies for patients suffering from adolescent scoliosis.

Askin's Tumor in an Adult: Case Report and Findings on 18F-FDG PET/CT

Primitive neuroectodermal tumor (PNET) of the chest wall or Askin's tumor is a rare neoplasm of chest wall. It most often affects children and adolescents and is a very rare tumor in adults. In this case report, we present an Askin's tumor occurred in a 73-year-old male. The patient was admitted with a history of 3-month lower back pain and cough. In computed tomography, there was a lesion with dimensions of 70 × 40 × 65 mm in the superior segment of the lower lobe of the left lung. Positron emission tomography/computed tomography with 18F-flourodeoxyglucose revealed a pleural-based tumor in the left lung with a maximum standardized uptake value of 4.36. No distant or lymph node metastases were present. The patient had gone through surgery, and wedge resection of the superior segment of left lobe and partial resection of the ipsilateral ribs were performed. Pathology report with immunocytochemistry was consistent with PNET and the patient received chemotherapy after that.

Askin's Tumor: A Rare Chest Wall Neoplasm. Case Report and Short Review

Askin's tumor is a rare neoplasm of the chest wall with a dismalprognosis. We report the case of 16-year-old girl presenting with a painful mass on the right anterolateral chest wall. The patient underwent radical mass resection. Histopathology revealed an Askin's tumor infiltrating the 5th ipsilateral rib and pleura. The girl subsequently received postoperative chemo-radio therapy with a satisfactory response. This is the first reported case of Askin's tumor in Greece and we focus on the clinical, radiological,pathological and therapeutic aspects of this rare entity.

Low grade central chondrosarcoma of the fifth costotransverse joint

Chondrosarcoma (CHS) is the third most frequent primary malignant tumour of bone exceeded only by myeloma and osteosarcoma. It usually occurs in the trunk bones (pelvic girdle, shoulder, ribs) followed by the femur and humerus and is very rare in the spine accounting for about 5% of all CHSs. The majority of patients affected are over 50 years old. We report a case of a 22-year-old woman with a 2-month history of pain on the right side of the upper thoracic spine. Complete imaging work-up with radiographs, CT, MRI and digital subtraction angiography showed an osteolytic lesion of the right transverse process of T5 with extension into the ipsilateral rib and enhancing extracompartmental tissue involving the paraspinal muscles. Both CT-guided core needle biopsy and excisional biopsy were consistent with grade I central CHS with myxoid change and focal areas of Grade II CHS.

Traumatische Zwerchfellverletzung: notfallmedizinische Diagnose und Behandlung

BACKGROUND: Diaphragmatic injuries (DIs) occur relatively infrequently, but their diagnosis is often missed during the initial emergency department evaluation. Following approval by the Institutional Review Board, we explored our experience with emergency diagnosis and treatment of diaphragmatic injury in a mixed group of blunt and penetrating trauma patients. METHODS: The investigators conducted a retrospective analysis of all acute traumatic DI cases treated in a single university hospital from 1991 to 2002. Patients with chronic diaphragmatic hernias and those pronounced dead on arrival were excluded. Trauma cases were reviewed for mode of injury, clinical presentation, diagnostic workup, operative findings, associated injuries, and outcome. RESULTS: The study identified 45 DI patients (mean age, 43 years; range, 5–81). Pulmonary abnormalities were identified in all patients and were most frequently associated with high-speed motor vehicle accidents (73%), severe chest wall injuries (31%), and ipsilateral rib fractures (31%). All patients had life-threatening visceral injuries requiring emergency surgery. Shock, respiratory distress, pneumothorax, high splenic and hepatic injury grades, and orthopedic injuries correlated highly with DIs. Four patients (9%) died, none as a result of the diaphragmatic injury. CONCLUSIONS: Diaphragmatic injury should be suspected in trauma victims presenting with severe associated injuries. Diagnostic aids should be aggressively utilized for early detection. Emergency surgery for treatment of DIs minimizes the mortality associated with these high-risk traumas.