Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Operative Resection of a Chronic Flail Chest Nonunion Revealing Septic Pseudarthrosis: A Case Report

  • Robin Deville (Department of Thoracic and Vascular Surgery, Hopital Tenon, Assistance Publique–Hopitaux de Paris) ;
  • Justin Issard (Department of Thoracic and Vascular Surgery, Hopital Tenon, Assistance Publique–Hopitaux de Paris) ;
  • Anna Vayssette (Department of Thoracic and Vascular Surgery, Hopital Tenon, Assistance Publique–Hopitaux de Paris) ;
  • Jalal Assouad (Department of Thoracic and Vascular Surgery, Hopital Tenon, Assistance Publique–Hopitaux de Paris)
  • Received : 2023.03.28
  • Accepted : 2023.07.06
  • Published : 2023.11.05
Download PDF
⟨ Previous Next ⟩

Abstract

We report a case of chest wall resection for painful chest wall nonunion, 5 years after traumatic flail chest and a first attempt at surgical treatment. The decision was made to perform surgery again after 2 years of unsuccessful well-conducted analgesic treatment. During surgery, we found the same sites of pseudarthrosis and decided to perform parietectomy of the fifth, sixth, and seventh ribs. A Gore-Tex patch was used to bridge the gap created by the resection. In immediate postoperative care, the patient's pain was quickly and sufficiently eased by stage 1 and 2 pain killers. The results of bone samples taken from the pseudarthrosis sites all found Propionibacterium acnes. Five months after surgery, the patient had considerable improvement in pain sensations. Computed tomography showed healing of ribs, the plate in place, and no sign of complications.

Keywords

References

  1. Fabricant L, Ham B, Mullins R, Mayberry J. Prolonged pain and disability are common after rib fractures. Am J Surg 2013;205:511-6. https://doi.org/10.1016/j.amjsurg.2012.12.007 
  2. Liu X, Xiong K. Surgical management versus non-surgical management of rib fractures in chest trauma:a systematic review and meta-analysis. J Cardiothorac Surg 2019;14:45. https://doi.org/10.1186/s13019-019-0865-3 
  3. de Jong MB, Houwert RM, van Heerde S, de Steenwinkel M, Hietbrink F, Leenen LP. Surgical treatment of rib fracture nonunion: a single center experience. Injury 2018;49:599-603. https://doi.org/10.1016/j.injury.2018.01.004 
  4. Gausden EB, Villa J, Warner SJ, et al. Nonunion after clavicle osteosynthesis: high incidence of Propionibacterium acnes. J Orthop Trauma 2017;31:229-35. https://doi.org/10.1097/BOT.0000000000000770 
  5. Otchwemah R, Moczko T, Marche B, Mattner F, Probst C, Tjardes T. High prevalence of bacteria in clinically aseptic non-unions of the tibia and the femur in tissue biopsies. Eur J Trauma Emerg Surg 2020;46:1093-7. https://doi.org/10.1007/s00068-018-1010-z