Case Review Series
Share Your Best* Cases with Colleagues from Around the World
*Best = Bread-and-butter-teaching, challenging, interesting, stupefying, and more!
Learning is the process by which experience is
transformed into recognition [1]
Please join us online for a case review series presented by your chest wall injury health care colleagues, moderated by Kyle Schmitt, MD and Bradley Faliks, MD - dedicated CWIS Education Committee members.
The CWIS Case Review Series provides health care professionals an opportunity to present de-identified, HIPAA-compliant patient cases that provide unique and/or illustrative educational opportunities for learning. These practice-based cases of patients with chest wall injuries will be drawn from health care professionals at all levels of experience and from across various disciplines.
CWIS hosts Case Review Series on a monthly basis - and each activity includes a discussion of 2-3 cases, approximately 10 minutes each (5 minutes of the planned case presentation and 5 minutes of audience Q&A). The series is usually held on the fourth Wednesday of the month and the times will rotate to facilitate attendees in various time zones, including the following dates:
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- October 25, 2023 at 1600 MDT: Register here
- November 23, 2023 at 0700 MST: Register here
- December 23, 2023 at 1300 MST: Register here
Archive of previously recorded case review activities
Dr. Engler described a patient with rib fractures requiring delayed SSRF and cryoneurolysis. Dr. Sen explained her use of a novel application of cryoneurolysis to treat pain associated with a displaced sternal fracture. Dr. Faliks discussed a patient with a congenitally fused sternum and sternal fracture requiring repair.
Dr. Semon presented a challenging preoperative case of chronic costal margin rupture with intercostal hernia. Dr. Xia and Dr. Siddiqi presented two cases. The first case was a patient with an open chest wall injury requiring surgical stabilization. The second case was a patient with a retained hemothorax who underwent cryoneurolysis for pain control.
- Drs. Philip(Attending), Scarborough(PGY2) and Alex(PGY1) presented a challenging case of a delayed sternal fracture repair in a smoker who required reoperation and plate explant due to an infection.
Dr. White described a patient with multilevel far posterior-anterolateral flail segment repaired using PolyEtherEtherKetone(PEEK) implants, who required reoperation and subsequent fixation of his posterior fractures.
Dr. Greiffenstein presented an unusual case of intercostal margin rupture with flank hernia that was not apparent on initial laparotomy. Dr. Torina presented a challenging case of flail chest involving sternum, costochondral cartilage and anterior ribs. Dr. Bauman presented a case that appeared to be wound infection requiring plate removal, but actually more likely involved a rare immunologic phenomenon.
Dr. Selwyn Selvendran presented a case of plating with a large open contaminated wound and hemo/pneumothorax.
Kate Dale, NP presented with Dr. Bhavik Patel a case of a delayed chest wall reconstruction involving both rib and clavicular nonunions and a case of staged damage control chest wall reconstruction.
Keith Landale, trauma registrar, presented with Dr. Zsolt J. Balogh about a sternal fixation after a patient was trampled by a bull as well a case involving combined rib, clavicle, and scapula fixation.
Dr. Louis Nelson presented a case with Dr. Chris Wolff of an unusual configuration of plates across cartilage and sternum complicated by retained hemopneumothorax. Dr. Jaclyn Kliewer presented a case with Dr. Michael Renda of a large degloving injury that underwent SSRF and had positive bacterial wound cultures treated with IV antibiotics without hardware removal. Dr. Matthew Vassy presented a difficult case of fractures that were initially non or minimally displaced but had progressive displacement and eventual nonunion of unrepaired segments.
Dr. Janelle Lopez presented a case with mentor Dr. Lauren Van Sant involving displaced anterior costochondral junctions causing lung herniation.
Dr. Alexis Schweibinz described a case with Dr. Bill Devoe involving flail chest in a nonagenarian.
Riley Swenson, MS3 shared a case with mentor Dr. Peter A. Cole involving a patient who requested rib plates be removed for discomfort and years later suffered lung herniation.
Dr. Benjie Christie presented an unusual case of heterotopic ossification causing chronic pain, fixed by surgical excision. Dr. Tom White presented a case of a costal margin disruption repaired by surgical stabilization. Dr. Daniel Ricaurte discussed a case of a patient who developed a lung hernia through an unrepaired costasternal margin disruption requiring subsequent repair.
Dr. Adam Hansen presented a case of 11th rib fracture non-union and discussed the intricacies of subsequent surgical options. Dr. Boudreau presented a case of a delayed hemothorax secondary to liver injury from a rib fracture. Mr. LaRoque, with Dr. Cole, presented a unique case of heterotopic ossification of the chest wall resulting in restrictive lung disease.
Dr. Matt Sarsam presented a challenging case of a patient with bilateral flail chest and severe pulmonary contusion. Dr. Monte Roper presented a similar case of a patient with displaced rib fractures who was vent dependent, liberated from the ventilator shortly after surgical stabilization of rib fractures.
Dr. Evan Brownie presented a case of first rib non-union after trauma resulting in neurogenic thoracic outlet syndrome. Dr. Kaitlin Ritter presented a case of a traumatic diaphragmatic hernia in a frail elderly patient with associated rib fractures requiring repair.
Dr. Rich Lesperance presented a challenging case where there was hardware failure after plating onto the sternum. Dr. Casey Walk discussed a 6/7 chronic costal margin rupture successfully repaired with a titanium plate.
Dr. Chris Wolff presented a case of an 85-year-old with a complex stoved in chest after a ground-level fall, and discussed some of the challenges faced when plating complex fractures in elderly patients. Dr. Tareq Kheirbek presented an update on a case of a young man with a disrupted sternum and right costal margin with persistent right thoracic and axillary pain. Dr. Adam Hansen presented two cases: first - a case of rib mal-union alleviated with a flipped rib interposition autograft; and second - a case of persistent pain with bridging cartilage instability.
Drs. De la Cruz and Wullschleger presented a challenging case of a severe sternal fracture associated with a lung hernia. Dr. White presented a case of a sub-acute costal margin rupture and his repair technique. Dr. Edwards presented a challenging case of chest wall non-union in a patient who underwent multiple attempts at fixation followed by hardware removal, now pending definitive surgery.
Dr. Suzanne F.M. van Wijck presented a case of painful heterotopic ossification relieved with surgical resection and NSAID use. Dr. Sharma presented a case of a symptomatic acute 2nd rib fracture stabilized by SSRF.
Dr. William Long III presented a challenging case of a shotgun blast to the chest with defects that required spanning large rib defects, unique mechanical ventilation techniques, and treatment for lead poisoning. Dr. Tom White described a fascinating case of first rib non-union which he repaired with the assistance of 3D printing and a pre-bent plate, with excellent functional results.
Dr. Zach Warriner presented a challenging case of a patient with broken ribs after getting kicked in the side by a horse who later developed intercostal nerve entrapment with subsequent intercostal neuralgias. Dr. Steve Briggs discussed a clinical conundrum he was faced with - of a patient with multiple prior sternal surgeries for a congenital abnormality with a fractured sternal plate and ongoing pain. Finally, Dr. Tony Bacon provided a top-notch presentation on a tough non-union and chest wall hernia case which necessitated a modified Edwards Quilt repair.
Dr. Richard Miskimins presented a difficult case of sternal non-union after osteomyelitis from an infected traumatic sternal fracture. Drs. Mark Kryskow and Riann Robbins presented a case of traumatic lung herniation through disrupted a costochondral junction requiring repair. Dr. Colby Elder presented a unique repair of a traumatic diaphragmatic hernia which also disrupted the chest wall.
Dr. Gerard Bulter presented a patient who experienced blunt cardiac injury, an unstable spine fracture, and sternal and rib fractures that required SSRF before spine fixation. Medical student (and 2021 CWIS research presentation award winner) presented a challenging case of hardware failure after cardiopulmonary resuscitation. Dr. Jeff Choi presented a frail patient with extensive medical comorbidities who benefited from SSRF, and showed us the real-world application of the rib fracture frailty index.
Dr. Kovi Bessoff presented a case of an octogenarian with bad COPD with flail segments requiring stabilization. Dr. Evert Eriksson presented a challenging case of a patient with spastic cerebral palsy who had undergone shoulder arthroplasty who subsequently developed rib non-unions and debilitating radicular pain at the chest wall. Dr. Eriksson is seeking additional feedback from the case - if you have additional comments please email him at evert.eriksson@gmail.com.
Dr. Van Sant presented a demanding polytrauma patient with a grade V liver laceration, bilateral displaced rib fractures, and a displaced sternal fracture. Dr. Reiniak presented an engaging and challenging case of an open thorax after a motorcycle crash managed without permanent plates in a resource-limited setting. This presentation was translated in real-time by Dr. Patrick Greiffenstein.
Dr. Michael Renda described a case of penetrating thoracic injury with flail chest that instigated an invigorating discussion about plating in open wounds and soft tissue coverage. Dr. Tareq Kheirbek presented a case of a devastating seat belt injury requiring complex stabilization of the sternum and the costosternal junction. Dr. Ananya Anand presented a case of a man with a chronic intercostal hernia with costal margin rupture requiring repair with a modified Edward's patch.
Dr. Tung presented a difficult case of a patient with bilateral flail chest and multiple concomitant injuries requiring staged repair. Dr. Dantis presented a unique case of a young male with an open flail chest who was closed with a combination of polypropylene mesh, prolene sutures, and musculocutaneous flaps.
Dr. Baucom presented a case of a frail elderly patient with COPD who benefited from surgical stabilization of rib fractures. Drs. Long and Lottenberg presented and compared two cases of bilateral flail chest who underwent surgical stabilization of rib fractures. Timing of surgery and outcomes were compared.
Dr. Caroline Dunn and Dr. Adam Kaye presented a dramatic case of slipped rib syndrome requiring repair. Dr. George Phillip discussed his management of a considerable sternomanubrial dislocation. Finally, Dr. Essa AlGhunaim and Dr. Yousef Aleid presented a case illustrating the benefits of early surgical stabilization in patients with flail chest.
Dr. Stuart Chow presented a challenging case of rib non-union and possible costal margin rupture in a medically complex patient. Dr. Ashley Titan discussed the management of post-operative empyema in a post-SSRF patient with extrathoracic plates. Dr. Shahin Mohseni presented a patient with posterior rib fractures abutting the aorta which necessitated rib resection.
Dr. Andrew Nicholson presented an interesting case where stacked plates were used to address sternal fractures with adjacent rib fractures. Dr. David Hindin discussed a case of a patient with flail chest undergoing SSRF while on VV ECMO, who developed an empyema. Mr. Taylor Head presented a case of a patient with a prolonged air leak after SSRF.
- September 2020
Dr. Christopher Janowak presented about management of an empty hemothorax after trauma pneumonectomy associated with severe chest wall deformity. Dr. Peter Cole presented a lively case of a severe chest wall injury likened to a crushed "bag of Fritos" requiring multi-disciplinary. Dr. Matthew Wi presented a challenging case of sternal fixation after a clamshell incision for trauma.
- October 2020
Dr. Brian Crosser presented a unique case of traumatic rib fractures after inhaling difluoroethane (keyboard cleaner) with associated severe hypocalcemia. Dr. Patel and Dale presented a case of staged chest wall reconstruction in a patient with multiple medical co-morbidities with chronic chest wall instability. Finally, Dr. Matthew Wi presented on delayed rib fixation and VATS in a 90-year old male, highlighting some of the unique challenges and benefits of rib fixation in the geriatric patient population.
Dr. Wesley Vanderlan highlighted his posterior thoracic paraspinal approach to rib fractures close to the spine. Dr. Richard Miskimins provided an engaging talk on management of bear-associated chest wall injury - showcased by a unique black bear attack victim he managed. Drs. Brett Chapman and Patrick Greiffenstein presented a case of traumatic biliothorax, and how they managed to fix and stabilize associated rib fractures.
Dr. Adam Kaye discussed a patient with a delayed hemothorax requiring operation, and how he manages patients with delayed complications of rib fractures. Dr. Schulz-Drost described his minimally invasive techniques he employed to stabilize the chest of a patient who developed bilateral anterolateral flail chest after a crush injury. Finally, Drs. Matthew Wi and Eric Lau discussed their early experience with intrathoracic plating and got some great tips and tricks on intra-thoracic plating.
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- Kolb DA: Den erfaringsbaserede læringsproces [the experience based learning process]. Tekster om læring. Edited by: Illeris K. 2000, Roskilde, Roskilde Universitetsforlag, 47-66.
