unit. Available prosthesis includes stainless steel wires, metal plates or struts,
and absorbable plates and screws.
Reports of rib fixation in children are sparse in the pediatric literature and
it is still largely uninvestigated. Although it has been shown to be beneficial in
adults and short-term results may potentially be reproducible in children, there
are concerns regarding rib fixation with metal plates or struts in children. One
primary concern is that hardware implanted on a developing child’s rib cage
may inhibit future chest wall growth or result in chest wall deformity. Other
concerns include the long-term risk of infection of embedded hardware and
need for subsequent surgeries to modify or remove hardware. The utility of rib
fixation in pediatric thoracic trauma is yet to be determined. Additional studies
are required to define the appropriate indications in the pediatric population and
assess long-term outcomes in children.
E. Sternal and Scapular Fractures
Sternal fractures are rare in children. Direct blunt impact is the most
common mechanism of injury. On physical exam, a chest wall contusion may
be visualized and pain may be elicited with palpation of the sternum. Diagnosis
is made by AP and lateral chest x-ray or CT scan. The most common location
of fracture occurs at the sternomanubrial junction of the sternum. Although the
majority of sternal fractures are usually isolated injuries, they are associated
with cardiac dysrhythmias. Electrocardiogram (EKG) evaluation should be done