“Chest wall injuries comprising of ribs and the sternum are very common and we treat a lot of patients in our clinic”, says Dr Shyam Kolvekar. As the Internationally recognised surgeon for adolescent and adult NUSS procedure takes us through the fundamentals of fractures and deformities in the chest and shares techniques of treatment and surgery, he remarks, “the most common way of injury is through direct trauma such as a fall or a road accident.”
Rib fractures are extremely normal in patients who have had trauma affecting up to 20 per cent of all patients involved in a road accident. “In majority of cases, these are minor and lead to symptoms of pain and breathlessness. Occasionally they can lead to chest infections due to the difficulty in breathing.” This can often be diagnosed on an X-ray or a CT scanner.
Dr Kolvekar classifies these rib fractures based on its complexity: “Usually when one or two ribs are fractured, they might not necessarily be displaced. While multiple rib fractures are often displaced.”
Sternal injuries are less common and are often caused by trauma directly to the front of the chest such as falling on the front or a steering wheel compressing the chest in a car accident.
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The mainstay of treatment for rib fractures comes down to adequate pain relief. “Fractures that are not displaced will often heal with time. However, sometimes the pain can be chronic. We can help with this using targeted therapy such as trigger point injections.”
He further adds, “the treatment for unrecovered ribs requires surgery which involves using metal plates to realign the ribs together again. We offer a surgical procedure called an open reduction and internal fixation using titanium plates.”
Sternal injuries mostly heal with time and are often treated with pain killers. However, they can be quite complex if they involve a complete fracture and displacement of the breastbone. Very rarely this can lead to internal injuries such as damaged to the heart. “More complex sternal injuries, especially if they are displaced may require surgical correction with metal plates in a similar principle to that of rib fractures.”
Pectus deformities such as pectus excavatum or ‘sunken chest’ and pectus carinatum or ‘pigeon chest’ appear noticeable in children and adolescents, says Dr Kolvekar. “Surgical correction through implants, NUSS insertion or the Ravitch procedure are recommended in the case of excavatum while the first line of treatment for carinatum is bracing.”
The decision to have a surgery largely depends on the severity of the pectus deformity and any associated functional or psychological issues.
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Recently, NHS has decommissioned all forms of surgical and non-surgical treatments of pectus deformities. “We have been actively campaigning to re-instate NHS care for pectus deformities since such deformities can have a profound effect on the development of young patients both physically and psychologically,” strongly expresses Dr Kolvekar.
On affordability he voices: “Treatment of pectus deformities can be very expensive and is therefore not accessible to everyone. No patient should be denied treatment.”
Dr Shyam Kolvekar is a Consultant Cardiothoracic Surgeon at St. Bartholomew’s Hospital in the City of London. He practices at the Royal Free Hospital, Harley Street Clinic, Wellington Hospital and London Clinic. He specialises in mitral valve repairs, beating-heart surgery, cardiac arrhythmias, correcting chest wall deformities, pneumothorax and lung cancer. He is an internationally recognised surgeon for adolescent and adult NUSS procedures.
*Info: St. Bartholomew’s Hospital
