RibXcar with Dots Point Technique: The Science of Fracture as a Safety Principle

Minimally invasive percutaneous aesthetic rib reshaping (RibXcar) aims to reduce waist circumference through rib angulation produced by controlled monocortical fractures. Achieving a precise fracture path while avoiding bicorticality is essential to minimize complications. This study compares 2 corticotomy orientations used for rib remodeling: perpendicular corticotomy (point-to-point, dots point) and parallel scraping (no dots point).

Fifty porcine ribs from 24-kg Yorkshire pigs were randomly assigned according to corticotomy orientation. Rib dimensions were recorded using standardized instruments. The force and time required to generate monocortical and bicortical fractures were measured with a calibrated digital dynamometer. Data were collected in a standardized format and analyzed using IBM SPSS Statistics Version 25 (IBM Corp.).

Rib weight and size were comparable between groups. Perpendicular corticotomy required significantly less force than parallel scraping to achieve monocortical fractures (6.67 ± 1.07 N versus 14.54 ± 1.27 N; P < 0.001) and bicortical fractures (10.0 ± 1.0 N versus 17.83 ± 0.83 N; P < 0.001). Monocortical fractures were obtained faster with the perpendicular technique (5.43 ± 0.86 s versus 6.19 ± 0.54 s), whereas bicortical fractures occurred more rapidly with the parallel scraping approach (3.63 ± 0.63 s versus 7.90 ± 0.71 s).

In this ex vivo model, perpendicular corticotomy demonstrated biomechanical advantages by requiring less force and allowing better control to achieve safe monocortical fractures, whereas parallel scraping favored earlier bicorticality. These findings suggest that perpendicular corticotomy may provide a safer and more predictable strategy for rib remodeling.