Treatment of posttraumatic sternal non-union with a locked sternum-osteosynthesis plate (TiFix)

Only a minority of sternal fractures require osteosynthesis. Unstable non-union of the sternum is a very disabling condition which often requires treatment. The method most often used is tension-wiring. Due to loosening of the tensile strength or wire cut-out, this method often fails. We report the results of locked plate osteosynthesis of sternal non-union and displaced fractures.Over a five-year period, 12 patients have been treated using this method in a multicentre trial. Mean age at trauma was 32.8 years, the implant used in all cases was an 8-hole titanium plate, the fixation of the screws is based on the principles of angular stable fixation.In all cases the index procedure was possible, in all cases there was bony healing at follow-up examination.Multidirectional locked plating offers a reliable method for the successful treatment of sternal non-union and displaced fractures.     

Stress fracture of the radius following non-union of an isolated fracture of the ulna

Summary Non-union of the ulnar diaphysis after isolated ulnar shaft fracture is uncommon. Complications due to non-union of the ulna must therefore be very rare. A case of a stress fracture of the radius in a postmenopausal woman following an isolated ulnar shaft fracture and non-union is presented. The mechanism of the stress fracture and propositions for preventing non-union of the ulnar shaft after an isolated fracture in the osteoporotic patient are discussed.     

The prevalence of established scaphoid fracture non-union found on incidental radiography

A hospital radiology reports database was used to determine the prevalence of non-union of scaphoid fractures. Radiographs taken for any indication were used. By using a large number of radiographs, variations attributable to bias were minimised. There was a 0.14% prevalence of established scaphoid fracture non-union in the general population, indicating that unrecognised scaphoid non-union is rare.     

Ipsilateral gonarthrosis and stress fracture of the tibia

Insufficiency fractures of the proximal tibia with non-union, are relatively rare and difficult to treat with ipsilateral osteoarthritis of the knee. We report a case of symptomatic osteoarthritis of the knee, with non-union of a stress fracture of the ipsilateral proximal tibia treated with posterior stabilized total knee arthroplasty with a long stemmed tibial component to stabilize the non-union fragments.     

Chondromyxoid fibroma of the sternum

Primary chondromyxoid fibroma (CMF) of the sternum is quite rare with only four cases documented in the literature. We present a new case of CMF arising from the sternum of a 47-year-old man and compare it with the previous cases.     

Tuberculous osteomyelitis of the sternum: successful management with debridement and vacuum assisted closure.

Primary Mycobacterial infection of the sternum is an exceedingly rare occurrence. We present a case of tuberculous osteomyelitis of the sternum successfully treated with surgical debridement and vacuum-assisted closure therapy.     

Giant cell tumor of the sternum.

A primary giant cell tumor (GCT) originating from the sternum is extremely rare. We report a case of a GCT originating from the sternum in a 45-year-old man who was referred to us for a mass in the anterior chest wall that had been growing slowly. Computed tomography revealed a soft tissue mass involving a large osteolytic and destructive lesion of the sternum body. Subtotal sternectomy and reconstruction with methylmethacrylate were performed. The tumor was 8.5 x 4.5 x 2.5cm, and the histopathological examination confirmed GCT. Radical wide resection of primary sternum tumors and reconstruction with an appropriately rigid prosthetic material are necessary to minimize local recurrence.     

Surgical repair of incomplete cleft sternum and cardiac anomalies in early infancy

Congenital cleft sternum is a rare congenital anomaly due to lack of fusion of the lateral mesodermal plates. We report two cases of incomplete superior cleft sternum associated with cardiac anomalies that underwent successful complete surgical correction.     

Giant cell tumor of the sternum

A primary giant cell tumor (GCT) originating from the sternum is extremely rare. We report a case of a GCT originating from the sternum in a 45-year-old man who was referred to us for a mass in the anterior chest wall that had been growing slowly. Computed tomography revealed a soft tissue mass involving a large osteolytic and destructive lesion of the sternum body. Subtotal sternectomy and reconstruction with methylmethacrylate were performed. The tumor was 8.5 × 4.5 × 2.5?cm, and the histopathological examination confirmed GCT. Radical wide resection of primary sternum tumors and reconstruction with an appropriately rigid prosthetic material are necessary to minimize local recurrence.     

Primary repair of a large incomplete sternal cleft in an asymptomatic infant with Prolene mesh

A cleft of the sternum is a rare congenital anomaly, often diagnosed as an asymptomatic condition at birth. We present a case of a large incomplete sternal cleft in a full-term baby boy. Surgical repair of the sternum with the use of Prolene mesh was performed during the neonatal period without cardiac compression.     

Non-union of the clavicle in a child. A case report.

A case of symptomatic non-union of the clavicle occurred in a 12-year-old boy. Differential diagnosis roentgenographic and histologic observations, including the results of resection of the non-union site and stablization of the proximal clavicle using the coraco-acromial ligament demonstrated that this rare condition can be restored to full asymptomatic function without any internal metallic fixation devices.     

Surgical management of the cleft sternum

Cleft sternum is a rare disturbance of unknown origin in the normal central midline fusion. Three cases of upper cleft sternum are reported here, one associated with a pericardium to the skin sinus tract. Surgical correction of this anomaly in the neonatal period is advised, whether the infant is symptomatic or not. Simple closure of the defect during the first month of life avoids the more complex reconstruction necessary in older children.     

Genicular corticoperiosteal flap salvage of resistant atrophic non-union of the distal radius metaphysis

Non-union at the metaphyseal level is rare following a fracture of the distal radius. When a non-union does occur, it is usually easily treated with cancellous bone graft from the iliac crest. Resistant and multiply operated atrophic non-unions more frequently occur at the diaphyseal level of long bones. A corticoperiosteal free flap based on the articular branch of the descending genicular artery has previously been described to treat such difficult non-union cases in various sites, but not at the distal radius. At the distal radius metaphysis, the close relationship with the extensor tendons raises concern regarding the ability to fit this free flap to the non-union site without significant interference with tendon function. By careful technique of crumbling the cortex of the flap without tearing the periosteal continuity, the flap can be contoured and snugly fit to this particular site while preserving tendon function. A unique case is presented of a multiply operated resistant atrophic non-union of the distal radius metaphysis in a heavy smoker that was rapidly healed using the genicular corticoperiosteal free flap.     

Non-union of calcaneum – A rare complication of calcaneal fracture – A case report with brief review of literature

Intra-articular fractures of calcaneum are known to be difficult to manage and lead to multiple complications including subtalar arthritis and malunion. However, non-union of calcaneum is rarely encountered. Only a total of six studies reporting on 12 patients could be found on reviewing the available literature (English language only). One such case of non-union of calcaneal fracture and its successful management is being reported in this case report. In addition, extremely limited literature available on calcaneal non-union is also briefly reviewed. Role of subtalar arthrodesis with internal fixation of fracture and bone grafting for successful management of this rare complication is highlighted along with the possibility of under-reporting of this relatively unknown complication.     

Aneurysmal bone cyst of the sternum.

A very rare case of aneurysmal bone cyst of the sternum is described. Aneurysmal bone cyst is a tumorlike bone lesion occumng commonly in the metaphysis of long bones and in the vertebrae. This report is one of the very few cases in the literature of aneurysmal bone cyst of the sternum. Total resection of the tumor and reconstruction of the sternal defect using autogenous fibula are presented     

Surgical treatment of non-unions of the clavicle

Surgical Principles A non-union of the clavicle can develop following a fracture, which is conservatively treated with insufficient reduction or inadequate immobilisation, as well as after an open reduction and internal fixation in cases with severe soft tissue injury or with poor osseous stabilization. Dynamic compression plating of a non-union of the clavicle provides the mechanical stability required for bone healing; in cases of atrophic non-union or pseudarthrosis with loss of bone, the procedure is supplemented with an autogenous cancellous bone graft, whereas those with associated shortening are treated with the interposition of a cortico-cancellous block. The (rare) post-traumatic thoracic outlet syndrome can frequently be treated successfully through a stable internal fixation of the pseudarthrosis. First published in: Operat. Orthop. Traumatol. 1 (1989), 139–144 (German Edition).     

Intraosseous neurilemoma of the sternum.

Sternal benign bone tumor is uncommon. We report a very rare case of intraosseous neurilemoma in the sternum. A girl, 10 years of age, was diagnosed as having a sternal tumor. Computed tomographic scan disclosed a mushroom-shape tumor in the region from inside of the sternum to the ventral soft tissues. Surgical resection was performed. Histopathologic findings showed a typical neurilemoma with Antoni type A and B patterns. No recurrence has been found.     

Solitary eosinophilic granuloma of sternum

Primary bone tumors of the chest wall are uncommon, although a wide variety of both benign and malignant tumors arise within the chest wall. Among those tumors, sternal tumors are rare and usually malignant. We report an extremely rare case of eosinophilic granuloma developed in the sternum in a 30-year-old woman. She presented anterior chest pain and somewhat tender mass over the sternum. Chest roentgenogram, computed tomography scanning of the thorax, and total body bone scintigraphy revealed an isolated lytic lesion in the corpus sterni. A tru-cut biopsy of the mass exhibited the typical histologic appearance of eosinophilic granuloma. The solitary lesion was removed completely surgically. This rare condition should be kept in mind in differential diagnosis of sternal lesions.     

Tardy ulnar nerve palsy after fracture non-union medial epicondyle of humerus – An unusual case

Tardy ulnar nerve palsy is a chronic clinical condition characterised by delayed onset ulnar neuropathy. Typically tardy ulnar nerve palsy occurs as a consequence of non-union of lateral condyle in child resulting in cubitus valgus deformity which ultimately is the cause of ulnar nerve palsy. However very few literature are available for tardy ulnar nerve palsy as a result of old fracture of medial epicondyle without cubitus varus or valgus deformity. We report a rare case of tardy ulnar nerve in an adult male with fracture non-union of medial epicondyle of humerus.     

Giant cell tumor of the sternum: a case report

We report a rare case of giant cell tumor (GCT) of the sternum in a 55-year-old man. He presented with a bony mass in the body of the sternum that had been slowly growing over 6 months. The patient was treated by surgical curettage and cementation. Histological study showed typical GCT findings with cytogenetic abnormalities of many telomeric associations of chromosomes, predominantly the 19q arm.