Pectus Bar Dislocation: Comparison Between Three Different Stabilization Techniques Adopted in a Single Centre
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Francesco Donati, Maria Stella Cipriani, Angela Pistorio, Vittorio Guerriero, Girolamo Mattioli, Michele Torre
Background: Bar dislocation has always been considered a fearsome complication of Minimally Invasive Repair of Pectus Excavatum (MIRPE), therefore multiple techniques and types of stabilization have been introduced. The aim of the study is to compare different stabilization techniques in a cohort of patients operated by the same first operator.
Methods: MIRPE was adopted at our institution in 2005. Data on MIRPE patients from January 2013 to December 2022 were collected prospectively and reviewed. Patients with a follow-up of at least 12 months were included. Throughout the years different ways of stabilization were used. Patients were divided in 3 groups according to the stabilization strategy adopted- Group A: no stabilizer; Group B: single bar fixation; Group C: bridge fixation. Dislocation was diagnosed if a bar rotated more than 30° or displaced laterally for more than 1.5 cm. We compared bar dislocation percentage of each group.
Results: We positioned 733 bars in 468 patients. Group A included 113 bars (15.4%), Group B 415 bars (56.6%), Group C 205 bars (28%). No patients were lost at follow-up. Total dislocation rate was 4.1% (30 bars). Dislocation was observed in 10 bars of group A (8.8%), 20 bars of group B (4.8 %), 0 bars of group C (0%). Differences between groups were statistically significant.
Conclusions: The use of stabilizers reduced dislocation percentage. In particular, bridge fixation technique reduced to zero bar dislocation and is now our preferred technique of stabilization.
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In patients with pectus excavatum who need a bar surgically placed, how do you prevent it from dislocating? I'm Lizzie Lee in Cincinnati Children's Hospital, and this is an article you should know about. This was an observational perspective study in Italy from 2013 to 2022 on 468 patients around 15 years old. The surgeons placed 733 bars total, and they wanted to figure out the best technique for preventing the bar from dislocating. Dislocation is when a bar rotates more than 30 degrees out of place. So what did they find? Bridge fixation was significantly more stable than single bar fixation. None of the patients with bridge fixation had dislocated bars compared to those who underwent the single bar technique. This means that bridge fixation is the best for preventing bar dislocation in pectus excavatum patients. Let us know what you think in the comments below and stay tuned for more articles that you should know about.