MatrixRIB Fixation System
William Long, Mario Gasparri, Stephan Schulz-Drost, Arthur Martella, Edward Black
Fig 1: MatrixRIB precontoured locking plates. MatrixRIB - A comprehensive system
The new MatrixRIB Fixation System is indicated for the fixation and stabilization of rib fractures, fusions and osteotomies of normal and osteoporotic bone. It was first developed under the guidance of the Sternal Surgery Working Group, an international group of cardiothoracic and plastic surgeons within the CMF branch of the AOTK System.
This new system is based on the Matrix platform of plates and screws that have been developed for all areas in CMF surgery. It consists of precontoured locking plates, locking screws, and intramedullary splints for the fixation and stabilization of ribs (Fig 1) and is indicated for the fixation and stabilization of rib fractures, fusions and osteotomies of normal and osteoporotic bone.
Reconstruction of the chest wall using metallic rib systems is gaining popularity. The AOTK Approved MatrixRIB system involves the use of plates and screws to bridge any defect and provide support for the chest wall following resection. It is a unique system offering stable fixation of normal and osteoporotic ribs combined with a minimally invasive technique. Although many rib fractures are treated conservatively, some patients benefit from surgical stabilization. The potential benefits of surgical intervention include reduced duration of mechanical ventilation support, shortened ICU stays and hospitalization, better secretion management through efficient cough and minimized chest wall deformities resulting from trauma.
Instrumentation
The specially developed instrumentation includes three plate holding forceps to assist the positioning of the plates during drilling and screw insertion procedures. These forceps are designed to be inserted from the superior aspect of the rib and hold the plate to the rib. The large version spans across multiple ribs to minimize the number of incisions in the intercostal space.
Case image provided by W Long, Portland, OR
Caliper
The new universal caliper is designed for easy readability, durability, and compact size. In comparison with the currently available flat caliper this device also offers improved handling capabilities yet is easier to clean. The calibrated markings are etched in black on an off-white arm extension, which has a square shape and is etched on all four sides. The extensions arm is made of radel (polyphenylsulfone (PPSU)) for better durability. It is intended for various areas of thoracic surgery, ie, with the sternal fixation system and the matrix rib system.
Fig 5: New caliper (top) and old caliper (bottom) Fall from 4-meter height
Mechanism of injury: An 81 year old woman fell onto her back from a height of 4 meters. (Fig 6a-d) She sustained a multiple sternal fracture concomitant with a fracture of the 5th thoracic vertebra resulting in an unstable injury of the trunk. Fortunately she did not show any neurologic deficit or paraplegia.
Diagnosis: Complex sternal fracture with multidirectional instability (longitudinal fracture of the manubrium, transverse fracture involving 3 levels of manubrium and corpus sterni) Concomitant to this was a fracture of the 5th thoracic vertebra (AOB2.1).
Treatment: The sternal fracture has been managed by open-reduction and internal fixation with a locked plate osteosynthesis (MatrixRIB, I-Plate) through an anterior approach in the mid-line. b The thoracic spine has been managed employing dorsal instrumentation (internal fixator th4-th6).
Post-operative outcome: The wounds and bone healed uneventfully. Breathing was possible spontaneously without any restrictions. The patient reported on a significant reduction of the pain immediately after the operative procedure. Mobilization on the ward started on the first day after the procedure. No complications such as secondary failure, non-unions, pain or deformity of the chest wall could be seen during the follow up examinations of 6 and 12 weeks and 6 and 12 months.
Fig 6a: Complex sternal fracture with multidirectional instability; a longitudinal fracture. 
Fig 6b: Transverseb fracture involving 3 levels of manubrium and corpus sterni. 
Fig 6c: Intraoperative view - fixation 'all in one' with I-plate (during MPE) This specific plate has now been recalled and re-designed. 
Fig 6d: Postoperative result - sufficient reduction and fixation of the sternum. A concomitant fracture of the 5th thoracic vertebra had been fixed during the same procedure. Pectus Excavatum
Clinical problem: A 21 year old male suffered from a recurrent pectus excavatum. Two years prior he underwent an open procedure to manage the deformity, including the insertion of one trans-sternal metal bar to stabilize the anterior chest wall (Fig 7a). Upon removal one year post-op, the anterior chest wall collapsed again and showed instability at the Sternocostal-junction involving ribs at the 4th 7th level.
Diagnosis: Recurrent pectus excavatum Unstable and dislocated Sternocostal-junction, 4-7th level.
Treatment: Another open approach was necessary. The anterior chest wall was mobilized and stabilized with the MatrixRIB 30-hole straight plate adopting a rib to sternum to rib approach at the 4th level. A bilateral sternocostal fixation at the 7th level was also performed using the MatrixRIB 8-hole straight plate (Fig 7b). The transverse plate was fixed to the anterolateral aspect of the ribs through additional limited incisions bilaterally (Fig 7c). The 5th and 6th pair of ribs were reduced to the sternal level alongside the 7th rib. Strong sutures (PDS 1mm, BPT-3) were placed sternocostal to fix the ribs to the sternum.
The patient recovered well. Wound healing was uneventful. Both cosmetic and functional results were excellent. Mobilization could occur immediately after the operation. No complications have been seen in more than 5 years of follow up.
Fig 7a: Recurrent Deformity 
Fig 7b: Chest x-ray showing transverse and sterno-costal plates 
Fig 7c: Anatomic reconstruction of the anterior chest wall. The treatment of chest wall deformity and pectus deformity using the MatrixRIB System
Minimal Invasive Rib Stabilization
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