Using electromagnetic navigation for intraoperative rib fracture localization during rib plating: A case report

INTRODUCTION: The precise localization of fractured ribs represents one of the primary challenges of surgical rib fixation. Computed tomography (CT) provides the facture’s general location, but it is difficult to use the imaging alone to properly place a surgical incision. We used electromagnetic navigation to identify the exact location of the fracture on the patient’s skin. PRESENTATION OF CASE: A 64-year-old man fell and suffered multiple left-sided nonunion rib fractures (4(th) to 9(th)). He was initially treated with a chest tube and analgesia, but he developed chronic pain from the injury. On the CT scan of the chest, the rib fractures were displaced and on exam, the ribs were mobile with reproducible pain and clicks on palpation. We used electromagnetic navigation to determine the fracture’s exact location on the skin during the operation, which aided in the location of the incision. The patient had open reduction and internal fixation of the broken ribs using rib plates. The patient had relief from his chronic pain after the surgery. DISCUSSION: The localization of the rib fracture on a patient’s skin can be performed using a physical exam, landmarks from the CT scan, or video-assisted thoracic surgery (VATS) procedure. Each of the techniques sacrifices either time or accuracy during the operation. The electromagnetic navigation can provide precise localization of the fracture without sacrificing too much time during the operation. CONCLUSION: The use of electromagnetic navigation to identify the fracture on a patient’s skin provides quick and accurate intraoperative localization for surgical rib fixation.