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LETTER TO EDITOR
Year : 2011  |  Volume : 55  |  Issue : 2  |  Page : 212-213  

Fracture of first rib after sternotomy


Institute of Anaesthesiology and Critical Care, Medanta-The Medicity, Gurgaon, India

Date of Web Publication22-Apr-2011

Correspondence Address:
Yatin Mehta
Institute of Critical Care and Anaesthesiology, Medanta- The Medicity, Gurgaon
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.79886

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How to cite this article:
Arora D, Mehta Y. Fracture of first rib after sternotomy. Indian J Anaesth 2011;55:212-3

How to cite this URL:
Arora D, Mehta Y. Fracture of first rib after sternotomy. Indian J Anaesth [serial online] 2011 [cited 2019 May 22];55:212-3. Available from: http://www.ijaweb.org/text.asp?2011/55/2/212/79886

Sir,

Rib fracture is a known complication following median sternotomy mainly attributed to excessive retraction. [1],[2] The symptoms depend upon the location of the fracture and associated brachial plexus injury. Sometimes symptoms persist because of occult rib fracture requiring special investigations like bone scan. [3]

A 71-year-old gentleman with coronary artery and ischemic mitral regurgitation presented for coronary artery bypass grafting (CABG) and mitral valve repair. He was suffering from hypertension and chronic renal disease. His preoperative investigations revealed serum creatinine of 1.8 mg/dl and blood urea of 109 mg/dl. The rest of the investigations were within normal limits. Chest radiograph revealed cardiomegaly and congested lung fields [Figure 1]. Echocardiography showed global hypokinesia of the left ventricle with ejection fraction of 30% and moderate to severe mitral regurgitation with predicted pulmonary artery pressure (PAP) of 50 mmHg. He underwent CABG with three saphenous vein grafts and mitral valve repair with Carpentier Edwards classic ring. Total cardiopulmonary bypass (CPB) and aortic cross clamp time was 161 and 108 min respectively. Total surgical time was 350 min. Sternal retraction was done with double-blade retractor. Intraoperative period was uneventful. During the postoperative period, the patient was haemodynamically stable with minimal inotropic support. Postoperative portable chest radiograph revealed fracture of the left first rib [Figure 2]. Patient was electively ventilated for 16 h postoperatively in view of high PAP and combined surgical procedure. Patient did not have pain, numbness or parasthesia in the left upper limb. There was no evidence suggestive of associated brachial plexus injury.
Figure 1: Preoperative chest radiograph

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Figure 2: Postoperative chest radiograph showing fracture of left first rib

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Rib fracture is common after sternotomy and often goes unnoticed. The symptoms depend on location of the fracture. One-third of the fractures are reported each in the first and second rib and the remaining third throughout the thorax. [3] Occult rib fractures are often a major cause of non-incisional chest pain in patients who have undergone sternotomy.

 
   References Top

1.Gumbs RV, Peniston RL, Nabhani HA, Henry LJ. Rib fractures complicating median sternotomy.Ann Thorac Surg 1991;51:952-5.  Back to cited text no. 1
[PUBMED]    
2.Woodring JH, Royer JM, Todd EP. Upper rib fractures following median sternotomy. Ann Thorac Surg 1985;39:355-7  Back to cited text no. 2
    
3.Greenwald LV, Baisden CE, Symbas PN. Rib fractures in coronary bypass patients: Radionuclide detection. Radiology 1983;148:553-4.  Back to cited text no. 3
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    Figures

  [Figure 1], [Figure 2]



 

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