thoracic/chest wall

Question 1

ribs

Answer 1

7 true ribs articulate with sternum
8-10 false ribs indirect articulation
11-12 floating only articulate with vertebra

Question 2

classification sternal infections

Answer 2

Type I: early (days) antibiotics, explore with debridement and closure
Type II: early (weeks) usually purulent; debride and flap coverage to obliterate dead space
Type III: late (months) draining sinus with osteomyelitis. Debride with flap coverage to obliterate dead space

Question 3

indication rigid repair chest wall

Answer 3

defect >5cm

defect 4-5 ribs or larger (flail chest)

Question 4

pectus excavatum

Answer 4

retrodiplaced sternum lower 1/3 to 1/2

male: female 4:1
ravitch: cartilage resection/detachement and bar placement
nuss: “turnover” bar placed retrosternal to provide deformational pressure

Question 5

poland syndrome

Answer 5

right: left 2:1
abnormal development of subclavian artery
associated conditions: mobius syndrome (underdeveloped CN Vi and VII) and klippel-feil syndrome (fusion cervical vertebrae)