# Surgical management of complex non-union in chest wall instability: focus on posterior rib fractures, parasternal cartilage rupture, and costal margin injury

## TL;DR

This paper discusses surgical treatments for chest wall instability caused by non-union fractures and cartilage rupture, showing how modern techniques can restore function and reduce pain.

## Contribution

The paper presents novel surgical approaches for complex chest wall non-unions using multimodal imaging and modern plating techniques.

## Key findings

- Combined posterior rib plating and costal margin reconstruction improved stability in a patient with posterior rib non-union.
- Trans-costosternal osteosynthesis and bone grafting successfully treated a parasternal cartilage rupture in a young patient.
- Multimodal imaging is essential for diagnosing complex non-unions in the chest wall.

## Abstract

Non-union of the chest wall is an underrecognized but functionally significant complication of thoracic trauma, particularly when involving posterior ribs, parasternal cartilage, and the costal margin. Complex instability patterns can result in persistent pain, mechanical dysfunction, and impaired respiration. We describe two patients with symptomatic chest wall non-union. Case 1 was a 62-year-old man with posterior non-union of the seventh and eighth ribs and a secondary costal margin rupture with intercostal hernia. He underwent combined posterior rib plating and costal margin reconstruction, nerve-sparing fibre-tape sutures, and double-layer mesh. Case 2 was a 25-year-old man with a radiographically occult rupture and pseudarthrosis of the third parasternal costal cartilage. He was treated with trans-costosternal osteosynthesis and local bone grafting. These cases illustrate that dynamic and multimodal imaging are often required to diagnose non-unions, and that contemporary plating and mesh techniques can restore stability, relieve pain, and permit early mobilization.