Surgical Fixation of the Coronal Separated Sternal Fracture in the Anterior Flail Chest using ZipFixTM and SternaLock Plating System

A 57-year-old male injured in a pedestrian traffic accident was transferred to our Regional Trauma Center. Immediate intubation was performed due to stupor mentality and respiratory distress at presentation. After resuscitation and physical examination, he was transferred to Trauma Intensive Care Unit. The chest computed tomography (CT) revealed multiple rib fractures at the bilateral anterior arch from 3rd to 6th ribs and comminuted fracture of the sternum (Fig. 1). He was diagnosed with anterior flail chest with concomitant injuries, i.e., fracture of the pedicle right at the 4th cervical spine, complex pelvic fracture including the right iliac wing, superior and inferior ramus of the bilateral pubis, sacrum ala, and intertrochanteric part of the right femur. On day 4 of hospitalization, rib CT was performed to evaluate sternum and rib fractures (Fig. 2). Five days later, surgical treatment was decided for the sternal fracture because weaning was still difficult despite reduced ventilator support and clear recovery of mental status. After a midline longitudinal incision between the 3rd and 5th costal notch, meticulous dissection was performed to expose healthy bones and 4th intercostal space. The DeBakey peripheral vascular clamp was used to carefully pass below the posterior segment, and then the Penrose tube was pulled and placed bilaterally (Fig. 3-1). Zipfix (Synthes GmbH, Oberdorf, Switzerland) was placed after the cutting needle passed through the Penrose tube. Hematoma removal was sequentially performed between the fragment and approximation, and then the Zipfix was tightened (Fig. 3-2). The 8-hole X plate of the SternaLock Blu (Biomet Microfixation Inc., Jacksonville, FL, USA) was used to transverse the fracture site (Fig.3-3). On postoperative day 2, the patient was How to Do It in Trauma eISSN: 2508-8033 pISSN: 2508-5298