Thoracoscopy-assisted Minimally Invasive Osteosynthesis for Sternal Body Fracture Repair Utilizing a Titanium Locking Plate: A Case Report

Introduction: Sternal fracture is a common complication of chest trauma but has a low incidence. Various treatments have been developed to reconstruct sternal fractures. Among these approaches, analgesia, corset fixation, and open reduction with wiring or plate internal fixation have been suggested. The use of newly developed minimally invasive plate osteosynthesis is a feasible method. In this study, we report a case involving a 31-year-old young man with a sternal fracture accompanied by a small amount of lung contusion. All procedures including retro-sternal dissection and fracture reduction with placement of the dual plate as railroad technique were performed using video-assisted thoracoscopic surgery. The minimally invasive thoracoscopic technique provided effective repair and rigid fixation with immediate relief from intractable chest pain that had persisted before surgery. The postoperative recovery was good. No pneumothorax or complications such as chest pain, paresthesia, or wound infection were observed at the 6-month follow-up visit. This case describes a novel method for internal fixation of sternal fractures under thoracoscopic assistance. Case Report: A 31-year-old male sustained injuries from a road traffic accident on May 16, 2024, and initially received treatment at a nearby government hospital. Two days later, he presented to our facility with chest pain and injuries to his right leg, wrists, and forearm. Physical examination revealed sutured wounds on the right wrist and elbow, along with external fixation on the right leg. Due to the persistence of chest pain, a computed tomography scan was performed, which revealed a displaced sternal body fracture. The cardiothoracic vascular surgery team recommended surgical fixation because of the displacement and ongoing chest pain. On May 20, surgery was conducted by an orthopedic surgeon using a minimally invasive technique with video-assisted thoracoscopic assistance to ensure proper visualization and protection of vital structures during fixation with two long 3.5 mm pre-bent titanium locking plates using the railroad technique. Care was taken to ensure that the screws did not excessively penetrate the posterior cortex, which was confirmed through thoracoscopy. The post-operative recovery was uneventful, with significant improvement in chest pain noted at the 6-week follow-up. Conclusion: This case suggests that minimally invasive fixation with video-assisted thoracoscopy offers faster recovery, shorter hospitalization, and reduced tissue damage, ensuring proper reduction in sternal fractures. The low-profile 3.5 mm titanium locking plate using the railroad technique is an effective option for managing transverse sternal fractures. Keywords: Sternal fracture, thoracoscopically assisted osteosynthesis, locking plate.