A 15-year-old girl underwent a minimally invasive repair of pectus excavatum two months ago. During a recent cheerleading event she attempted to do a flip and felt a sharp right sided pain. She is now asymptomatic. A chest x-ray was performed (shown below).

 

 

[center][/center]

 

 

 

 

[size=20px]What is the best next step in management of the patient?

 

A Replace the stabilizer

 

B Observation

 

C Reposition bar

 

D Remove the stabilizer

 

E Place a second bar[/size]

Edited March 24, 20242 yr by Admin

C

E

a

A

B

Correct Answer

B Observation

 

The Xray shows the bar has dislodged from the stabilizer. Bar displacement is one of the major complications associated with the Nuss procedure. Numerous studies have tried to identify potential risk factors. Early return to contact physical activity and activities with excessive twisting can lead to bar displacement. Some studies have shown a decreased incidence of bar displacement with appropriate fixation to the rib and not solely to the soft tissue. Bar revision is required in patients that suffer bar dislodgement. Bar removal before three years results in a poorer clinical result and decreased rates of satisfaction. Excellent results are achieved in greater than 80% of patients if the bar is removed after three years. The trend is to leave the bar in place longer for better results. Younger patients benefit from longer-term bar placement to improve results.