title: Preliminary study on the effects of bar placement on the thorax after the nuss procedure for pectus excavatum using bone scintigraphy.
abstract: OBJECTIVE
  Bone scintigraphy was performed to elucidate the effects of the Nuss procedure for pectus excavatum on the bony thorax.
  
  
  METHODS
  Eight boys and 6 girls (5 - 24 years of age) underwent bone scintigraphy, using (99m)Tc-HMDP. Eleven patients were studied 5 to 21 days after the Nuss procedure; 6 were studied 20 to 24 months after the operation before bar removal. Three of 14 were studied twice after the Nuss procedure and before bar removal.
  
  
  RESULTS
  In the early postoperative phase, RI accumulation was found at the sternum and ribs in only 1 of 6 patients under 9 years of age, whereas in all 5 older patients, RI had accumulated at the sternum. Scintigrams before bar removal revealed, regardless of age, hot spots at the lateral ribs in contact with the bar and at the costochondral junctions where the bar passed through the intercostal spaces. Furthermore, chest roentgenograms showed the deformed lateral ribs in contact with the bar.
  
  
  CONCLUSIONS
  The Nuss procedure creates minute fractures at the sternum and the ribs, especially in older patients. The bar deforms the ribs and restrains the growth of the thorax. Furthermore, it constantly rubs against the ribs and can therefore cause late complications. Bone scintigraphy may determine the appropriate timing for bar removal.
authors.affiliation: Department of Pediatric Surgery, Osaka City General Hospital, Osaka, Japan. k-ohno@r2.dion.ne.jp
authors.forename: K
authors.initials: K
authors.lastname: Ohno
authors.forename: Y
authors.initials: Y
authors.lastname: Morotomi
authors.forename: K
authors.initials: K
authors.lastname: Harumoto
authors.forename: M
authors.initials: M
authors.lastname: Ueda
authors.forename: M
authors.initials: M
authors.lastname: Nakahira
authors.forename: T
authors.initials: T
authors.lastname: Nakamura
authors.forename: T
authors.initials: T
authors.lastname: Azuma
authors.forename: T
authors.initials: T
authors.lastname: Moriuchi
authors.forename: T
authors.initials: T
authors.lastname: Yoshida
authors.forename: C
authors.initials: C
authors.lastname: Shiokawa
authors.forename: T
authors.initials: T
authors.lastname: Nakaoka
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control; D005660:Funnel Chest / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D009984:Orthopedic Fixation Devices / Q000009:adverse effects; D019637:Orthopedic Procedures / Q000379:methods; D011877:Radionuclide Imaging; D013909:Thorax