Novel Repair of Disruption of the Costal Margin without associated

Diaphragmatic Hernia

Renée M. Tholey, Christine E. Feldmeier, Michael J. Walker

Eastern Cardiothoracic Surgery Society Annual Meeting

October 23-26, 2013

Patient Case Presentation

• We present a case of a 58 year old man with right-sided rib pain and shortness of breath following a fall on his left side.

• On physical exam there was an obvious disruption of the right anterior costal margin with a large separation between the eighth and ninth ribs causing chest wall instability.

Patient Case Presentation

• CT Chest demonstrated a herniation of lung between the eighth and ninth ribs.

• There was no evidence of a diaphragmatic hernia.

Patient Case Presentation• Our patient was taken to the operating room where a

novel technique was used to re-approximate and stabilize the eighth and ninth ribs by employing two Sternal Talon® devices.

Patient Case Presentation

• We put forth this case report as both a rare occurrence of costal margin disruption in the absence of diaphragmatic hernia, as well as a novel and never-reported technique to repair this abnormality.

• Stabilization of the patient’s chest wall provided relief of his pain, as well as improved lung mechanics.