Sternal plating for traumatic sternal non-union

Sternal non-union is a rare complication of sternal fracture but one which may impact patients symptomatically or cosmetically. Should conservative measures fail, the indications for operative intervention have become more defined in recent years and new techniques have been developed to restore sternal position and thus correct chest wall shape and function.

We present two cases of aseptic sternal non-union. Case 1 involved a young patient with a protracted history of sternal pain owing to an injury induced by repeated low-grade stress. Case 2 refers to another young individual who presented with persistent pain 1 year after suffering a fractured sternum in a motor bike accident.

Despite polarising inciting events, both were found to have non-union injuries to the sternum with evidence of pseudoarthrosis. We examine their management with parallel locking compression plate sternal fixation.

We also evaluate the current literature with respect to sternal plating, novel operative and non-operative alternatives, including recombinant human parathyroid hormone, and peri-operative considerations, such as closed incision negative pressure therapy. With ever improving access to axial imaging, particularly in the setting of trauma, these injuries are likely to increase in prevalence.