Occult Rib Fractures and Brachial Plexus Injury Following Median Sternotomy for Open-Heart Operations

• Published in: The Annals of thoracic surgery Vol. 38; no. 3; pp. 192 - 194
• Main Authors: Baisden, Clinton E., Greenwald, Lloyd V., Symbas, Panagiotis N.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-09-1984; Elsevier Science
• Subjects: Biological and medical sciences; Brachial Plexus - diagnostic imaging; Brachial Plexus - injuries; Cardiac Surgical Procedures - adverse effects; Coronary Artery Bypass; Female; Humans; Intraoperative Complications; Male; Medical sciences; Middle Aged; Radiography; Rib Fractures - diagnostic imaging; Rib Fractures - etiology; Sternum - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Heart; Human; Sternotomy; Nervous system diseases; Respiratory disease; Brachial plexus; Cardiovascular disease; Asymptomatic; Fracture; Trauma; Surgery; Location mark; Chest wall
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(10)62235-7

The incidence and the sites of rib fractures during open-heart operations through a median sternotomy incision were studied in 36 consecutive patients divided into two groups. In Group 1 (24 patients), a conventional Ankeney retractor was used to expose the heart, and in Group 2 (12 patients), a similar retractor was used but with its uppermost pair of blades removed. Thorough physical examinations and preoperative and postoperative chest roentgenograms were obtained, and postoperative bone scans were done in all patients. No rib fractures were detected on the routine chest roentgenograms in patients in either group. Bone scans, however, showed 44 rib fractures (15 of the first rib, 13 of the second rib, 4 of the third rib, 6 of the fourth rib, 3 of the fifth rib, and 3 of the sixth rib) in 16 patients in Group 1. Six patients in Group 2 had 9 rib fractures (2 of the first rib, 4 of the second rib, and 1 each of the third, fifth, and sixth ribs). None of the patients in Group 2 had brachial plexus injury and neither of the first rib fractures in this group were located posteriorly, whereas 3 patients in Group 1 had both brachial plexus injury and posterior first rib fractures.