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Rib fractures complicating median sternotomy
R V Gumbs1, R L Peniston, H A Nabhani
1Department of Radiology, Howard University Hospital, Washington, DC 20060.
The Annals of Thoracic Surgery
|June 1, 1991
Summary
Acute rib fractures can occur after median sternotomy, particularly in heavier patients. These subtle fractures, often involving the left first rib, may be missed on initial postoperative imaging.
Area of Science:
- Cardiothoracic Surgery
- Radiology
- Orthopedic Trauma
Background:
- Median sternotomy is a common surgical approach for cardiac procedures.
- Postoperative complications following sternotomy require careful monitoring.
- Rib fractures are a potential, though often overlooked, complication.
Purpose of the Study:
- To determine the incidence and characteristics of acute rib fractures after median sternotomy.
- To identify risk factors associated with rib fracture development.
- To highlight the diagnostic challenges of these fractures on postoperative imaging.
Main Methods:
- Retrospective review of 100 postoperative chest radiographs from patients who underwent median sternotomy.
- Analysis of fracture location, patient demographics, and surgical parameters.
- Correlation of fracture occurrence with patient weight and body surface area.
Main Results:
- Fifteen rib fractures were identified in 13 out of 100 patients.
- The left first rib was most commonly fractured (11 fractures).
- Fractures at the costotransverse articulation accounted for 7 of the 15 fractures.
- Heavier patients and those with larger body surface areas were more prone to fractures.
- Fractures were subtle and initially missed in 4 patients.
- No correlation found with operative time, bypass time, or ischemic time.
Conclusions:
- Acute rib fractures are an under-recognized complication of median sternotomy.
- Patient body habitus (weight, body surface area) is a significant risk factor.
- Radiographic subtlety necessitates high vigilance for diagnosis in the postoperative period.