2023 CWISummit Cine-session
Please note: Some of the videos in the CWISummit Cine-Session were flagged by YouTube as containing "content that may not be appropriate for viewers under 18 years old". CWIS is happy to post them for educational value, however we do honor the organization's efforts to keep the younger YouTube community viewing target audience appropriate.
These videos are easily viewable - it will simply require you logging into YouTube or Google (both have age-verification questions, and you will need to attest you are over 18 years old).
We think these educational videos will be helpful in the indicated topics - and look forward to sharing with you!
Presenter: Indraneel Brahme, MD
Background
Chest wall injuries can result in substantial pain, instability, and loss of function in patients who are not ready for surgery or undergoing nonoperative management.
Methods
A Rib Corset is a Lumbar corset that has been repurposed to be worn on the thoracic region and cinched tight to provide stability for the chest wall. By providing a snug compression of the ribs, and easy to use tension cables, a rib corset can provide added external support for patients, thus reducing pain and increasing their function. The corset can be easily prescribed to patients and can be customized with added padding, compression plates, and multiple sizes to ensure an appropriate reduction in symptoms for each patient.
Results
Dr. Cole has been using a rib corset for patients for several years now with resounding success. Many patients have been able to receive surgery after waiting several months or years. Others have even had such a reduction in pain that they decided not to have surgery despite a persistent defect of the chest wall.
Conclusion
A rib corset is an invaluable tool to have in a chest wall surgeon's armamentarium as it is versatile, easy to use, and effective.
Presenter: Adam Hansen, MD
Background
The reconstruction provides a successful options for cases of slipping rib syndrome that involve more than a simple 10th slipped rib. Specifically, it addresses multiple ipsilateral slipped ribs, rib deformities,
skeletal hypermobility issues, and offers a salvage technique after previous failed slipping rib operations.
Methods
The reconstruction solves the problems that are necessary for successful management of complex SRS cases. It relieves the intercostal nerve compression points, secures appropriate intercostal space,
permanently stabilizes the slipping ribs, and retains costal margin flexibility.
Results
This reconstruction was designed as a salvage operation for previous failed cases of costal cartilage excision in 2020. We found that it is also highly useful in nearly any slipping rib case, and now use it
exclusively in every case. It has been performed 198 times in over 155 patients (43 bilateral). Overall measured quality of life increased from a baseline mean of 36% to 77% at 6 months, 81% at 1 year, and
88% at 2 years. Breathing function increased from 63% to 97% at 6 months and 100% at 2 years.
Conclusion
Costal margin reconstruction solves anatomical and functional issues that are not fully addressed with other means of surgical treatment of slipping rib syndrome. It offers durable relief of pain and dyspnea,
and significantly improves overall patient quality of life.
Presenter: Feroze Sidhwa, MD, MPH, FACS
Background
Precise preoperative localization of rib fractures and immediate post-operative pain control can both be addressed through different uses of ultrasound in rib plating surgery.
Methods
We describe use of ultrasound localization of rib fractures to precisely center incisions, minimizing their length, and use of ultrasound to guide needle placement during intraoperative erector spinae nerve blocks.
Results
We have been supplementing surgical stabilization of rib fractures with ultrasound for three years, and we have found it to frequently be very helpful in minimizing incision length. Our experience with erector spinae nerve blocks over the past two years has anecdotally shown them to be an excellent adjunct to post-operative pain control.
Conclusion
Ultrasound is a useful adjunct to rib plating operations. It may be used to precisely place incisions in order to minimize their length, and may assist in regional anesthetic techniques for improved post-operative pain control.
Presenter: Thomas White, MD
Background
Fractures of the interchondral joint, typically between anterior ribs 6 - 7, can be challenging to diagnose and treat and are a rare cause of chronic chest wall pain.
Methods
We demonstrate surgical resection of a left interchondral joint and a unique head-mounted camera system, allowing for real-time interoperative consultation and mentoring between the operating surgeon in the United States of America and a more-experienced colleague from the United Kingdom.
Results
The operation was completed successfully and the patient recovered uneventfully. The patient remains pain-free at 3 month follow-up appointment.
Conclusion
Interchondral joint resection should be considered as definitive treatment for select patients with appropriate chronic pain syndromes. When available, live mentoring (in person or via use of technology) can be extremely valuable when performing unusual and/or rare cases.
Presenter: John G. Edwards, MD, PhD, FRCS(C-Th)
Background
Costal cartilage injuries are challenging to assess using conventional axial images. Static images and radiology reports can also be difficult for radiologists and surgeons to report.
Methods
Our hospital uses the Agfa Healthcare Enterprise Imaging system (Agfa HealthCare, Mortsel, Belgium). This allows the surgeon to process CT scans into 3D images on any computer in the hospital, without radiologist or technician support.
Results
This system, adopted across Sheffield Teaching Hospitals in September 2021, allows the surgeon to create diagnostic grade images themselves. The previous protocol required a significant allocation of 3D lab technician time in the 3D lab.
Conclusion
Since Enterprise Imaging was introduced, there has been no need to involve 3D lab technicians in the creation of 3D rendered images for costal cartilage injuries.
https://youtube.com/shorts/oTyp0cEjOOE?feature=share
Presenter: Monica Kathalina Rodriguez Perdomo, MS
Background
A patient who works in mining presents complex sternal trauma and instability of the chest wall.
Methods
Surgeon: Marcel Leonardo Quintero.
This injury leads to the need for stabilization of the chest wall and a complementary thoracoscopy for an associated coagulated hemothorax.
Results
The result was a recovery and monitoring in a critical care unit for 72 hours and subsequent transfer to the general ward and discharge in 72 hours, with a functional recovery of 100% without pain and incorporated into their daily activities.
Conclusion
In conclusion, chest wall stabilization and complement with thoracoscopy is an effective treatment for patients with complex sternal trauma and chest wall instability. This approach can address associated complications such as coagulated hemothorax and facilitate a quicker recovery time with functional recovery of 100%. The critical care unit is an essential component of care for these patients, ensuring close monitoring and management of potential complications. With appropriate management, patients with complex sternal trauma can return to their daily activities without pain and achieve excellent outcomes.
Presenter: Hadley Wilson, MD
Presenter: Indraneel Brahme, MD
Background
Plates and screws used for surgical stabilization of the ribs may require removal for a variety of reasons including plate breakage with nonunion, bursitis or crepitance of soft tissue, and hardware failure. This problem is amplified when plates and screws are "cold-welded" together. These tips and tricks will help surgeons learn various strategies to successfully remove cold-welded hardware in complex chest wall cases.
Methods
There are several strategies to remove cold welded hardware. The first trick explained involves the use of a crown drill to drill around screw shafts which have been retained in the ribs due to either stripped or broken screw heads. The second depicts a useful method to remove a plate with one, distal, cold-welded screw by either cutting or bending a plate and then unscrewing the remaining fragment. Finally, the third trick is for plates with multiple cold-welded screws. Here we utilize microsaw sets with carbide saw/burr bits to cut plates into fragments. Fragments without screws can be easily removed. Fragments with screws can then be unscrewed out.
Results
The senior author (PAC) has been performing similar tricks on his complex chest wall patients for several years now with resounding success. Many patients have gone on to have complete resolution of symptoms. As of recent, many complex chest wall patients are now being referred to him for similar issues of hardware failure and pain.
Conclusion
Chest wall hardware can cause substantial pain and discomfort for patients when the plates are broken or cause bursitis. These tips and tricks may provide guidance to allow for easier removal of hardware when necessary, particularly in cases of complex cold-welded plates and screws.
Presenter: Monica Kathalina Rodriguez Perdomo, MS
Background
Patient who presented thoracic trauma resulting in multiple rib fractures in different locations of the thorax.
Methods
This led to the use of different types of osteosynthesis materials to make the procedure more comfortable.
Results
The good results are evident during the video. Patient who is reincorporated in their daily activities without pain and without difficulty of mobility.
Conclusion
The results presented in this video suggest that the utilization of different types of osteosynthesis materials for the treatment of multiple rib fractures can lead to successful outcomes and improved quality of life for the patient. These findings may inform future clinical decisions in the management of thoracic trauma with multiple rib fractures.