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Paper text:
a 43-year - old man , impacted in his chest by a car accident , complained of severe chest pain in his anterior chest wall with palpable sternal instability .
computed tomography ( ct ) of the chest showed a displaced compound mid - body sternal fracture ( fig .
1 ) . troubled with fracture of several cervical bones accompanied by sternal fracture , he was scheduled for open sternal fixation 3 days after the trauma because of combined operation with spine surgery .
open reduction and internal fixation of the sternum was performed using the sternalock system ( biomet microfixation inc . ,
after a midline longitudinal incision over the sternum , the fracture site was carefully debrided of any fibrous union and old hematoma to expose healthy bone . before plate fixation , manual reduction of the sternal fracture
was assisted by the use of bone reduction forceps placed within the surrounding intercostal spaces .
three 4-holed straight plates were used vertically and horizontally due to compound sternal fracture ( fig .
2 ) , manually contoured to the underlying sternum , and secured using self - drilling , self - tapping screws . the screw length was 10 mm , which was chosen by the thickness of the sternum ( as measured on chest ct ) at each point of screw placement .
the patient was not discharged because he was receiving rehabilitation treatment for his leg , which had been paralyzed due to the cervical spine trauma .
the 3-month follow - up demonstrated normal wound healing with no complaints of symptoms associated with instability .
sternal fractures are common after severe chest wall trauma . more than 95% of sternal fractures are treated conservatively , and there are few reports on the late sequelae or evolution of such fractures .
surgery is a viable option when severely displaced fractures of the sternum entail physical deformity and prolonged pain .
the rationale for surgical repair in our case was evident physical deformity associated with a relatively young age , uncontrolled pain , and combined surgery for cervical spine fractures .
open reduction and stainless steel wiring has been the mainstay of treatment . however , the advantage of this technique is only that it is less expensive than plating .
this technique takes advantage of the non - rigid nature of the wires , and the potential for wire pull - through can result in secondary sternal fractures or sternal nonunion . moreover , this technique is barely suitable for compound sternal fractures , which are not stabilized by the non - rigid wire .
more rigid fixation using a plate and screw system minimizes these risks . in our case
sternal plating systems , such as the sternalock system we used , incorporate a thinner cuttable section that spans the fracture line and can be easily divided using common wire cutters .
in contrast with other plating systems , the strongest point of sternalock uses self - drilling and self - tapping screws , eliminating the need for drilling and reducing the chance of injury to mediastinal structures . therefore , sternalock may enable more secure reductions .
in summary , we report the successful treatment of traumatic compound sternal fracture with open reduction and rigid internal fixation using the sternalock plating system .
a 43-year - old man experienced chest trauma due to a car accident . 
 compound sternal fractures with severe dislocation were seen on computed tomography of the chest . using a sternalock plating system with manual reduction , fixation of the sternal fracture 
 was successfully performed . 
 there were no complications related to the operation .