"Anchor-type" incision for surgical stabilization of anterior rib fractures: a single center experience and evaluation.

PURPOSE: Rib fixation is increasingly used, but bilateral anterior fractures are difficult to access. We assessed feasibility and outcomes of a single muscle-sparing "anchor-type" anterior exposure for bilateral parasternal fractures with or without sternal fractures.

METHODS

Single-center retrospective study at a level I trauma center from January 1, 2016 to April 30, 2024. Adults with bilateral parasternal rib fractures who underwent surgical stabilization of rib fractures (SSRF) through an anchor-type incision were included; sternal plating was performed when indicated. Collected variables included demographics, injury severity, fixation extent, and postoperative outcomes. Outcomes were postoperative complications and outpatient functional scores.

RESULTS

Twenty-five patients were included (mean age 55 ± 15 years; 84% male; median Injury Severity Score 21 [IQR 17-32]). A mean of 11.8 ± 3.4 fractures were stabilized with 9.6 ± 2.5 plates; sternal fixation was performed in 17 patients (68%). Mean postoperative ventilator duration was 2.1 ± 3.6 days. Tracheostomy was required in 4 patients (16%). Complications occurred in 3 patients (12%): surgical-site infection (n = 2), and wound dehiscence (n = 1). In-hospital mortality was 2 patients (8%). Follow-up was available in 21 of 23 survivors at 107 ± 87 days; the mean functional score was 4.1 ± 0.9 (out of 5) and 77.7% reported return to usual daily activities.

CONCLUSION

A single anterior anchor-type, muscle-sparing exposure provides reliable access for bilateral parasternal rib and sternal fixation with low morbidity and favorable early functional recovery. Multicenter comparative studies are warranted to evaluate pain, pulmonary complications, and longer-term function.