First Case:
Male patient 45 years old, presented to trauma department with motor vehicle accident (MVA), general condition was good with GCS 14, vitally stable. Examination showed bruising on chest with tenderness over upper chest. Primary survey showed suspicious appearance at manubrium at CXR so we proceeded with MSCT chest for further evaluation and it showed fracture of manubrium together with left sterno-clavicular joint fracture and no other abnormalities were detected. Planning for surgery is done after counselling the patient. We used 4-holes straight titanium plate for manubrial fracture and 4-holes orbital titanium plate with titanium 2.7 mm auto self-tapping screws for further stabilization at manubrio-sternal joint. Post-operative pain score was 1 compared with 7 pre-operatively {P-value (.034)} with early recovery and ambulation. Hospital stay was 2 days including the day of surgery. Early Post-operative follow-up showed excellent wound healing with no seroma nor surgical site infection.
Second case:
Male patient, 50 years old presented to trauma department with blunt trauma to chest because of motor vehicle accident. Patient was vitally stable, GCS 15 with agonizing pain. Appropriate analgesia is administrated together with primary survey which showed mid-sternal fracture at lateral CXR and no other abnormalities could be detected. MSCT chest was obtained for further evaluation of the fracture. It showed mid-sternal fracture. Counselling of the patient with planning for surgery is made. One orbital titanium plate is used for fixation of the fracture. Post-operative pain score was 1. Hospital stay was 2 days with early mobility and rapid recovery without any respiratory function complications.
Third Case:
Male patient, 45 years presented to our trauma department with motor vehicle accident, GCS could not be assessed due to motor system affection. Patient presented vitally stable with BP 110/70 , HR 85, SaO2 on Room air (RA) 97%. Primary survey showed abnormal sternal appearance on CXR together right radial fracture. MSCT chest showed manubrio-sternal joint fracture with mild lung contusion. MSCT spine showed cervical injury and patient needed collar for stabilization of cervical spine. Patient was unable to move both his legs and showed sensory level affection starting at T 10 dermatome (umbilicus). His right forearm was put in plaster of Pairs (POP) after orthopedics evaluation. Counselling of patient is done about options of fixation of his sternal fracture and planning for plate fixation is made after his choice and consenting. Although this patient has high associated injury scale (AIS) score, we were concerning about providing our patient with best options for better coping and faster recovery from his sternal fracture which was adding sever pain to his suffering. We used straight titanium plate with two orbital plates at each side for better stability of his sternum and pain recovery. His pain score was not reliable due to other confounding factors which are cervical agonizing pain and his sensory level loss. However, he showed excellent recovery post-operatively in the form of good wound healing, normal respiratory function tests without any deterioration which gives us a clue about stability and recovery of his sternum that caused no further pain which if persisted could lead to chest stitching pain with respiration leading to decrease inspiratory reserve volume, atelectasis and suppression of cough mechanisms with chest infections super-imposed. Hospital stay was 40 days due to orthopedics and neurosurgery follow-up.
Fourth Case:
Male patient, 55 years, presented with blunt trauma to his chest of high velocity. Primary survey of the patient showed no abnormalities. Sever tenderness on his chest raised our suspicious so we proceeded with MSCT chest. It showed fracture at his manubrium. We used H-shaped titanium plate. His Pain score was 2. His hospital stay was 4 days.
Fifth Case:
Male patient, 42 years old, was diagnosed with chondrosarcoma at the body of the tumor. MSCT chest is done for staging and evaluation of the patient alluding its suitability for excision. After discussion with patient and consenting, surgical excision was the decision. At exploration the mass had infiltrated the whole body of the sternum and overlying pectoral muscle. Surgical excision of the body of the sternum together with the overlying pectoralis is done leaving a big gap. Titanium mesh 20*10 cm is used fixed by 2 mm titanium screws and sandwiched between 2 layers of prolene meshes. Post-operative pain score was 2 at third day and he was discharged successfully at that day with good recovery. At 1 week post-operative follow-up, there has been good stability of chest wall with perfect wound healing.