title: Medial scapular winging associated with rib fractures and plating corrected with pectoralis major transfer.
abstract: BACKGROUND
  Rib plating is becoming increasingly common as a method for stabilizing a flail chest resulting from multiple rib fractures. Recent guidelines recommend surgical stabilization of a flail chest based on consistent evidence of its efficacy and lack of major safety concerns. But complications of this procedure can occur and are wide ranging.
  
  
  METHODS
  We report an interesting case of a 58-year-old male patient that worked as a long-distance truck driver and had a flail chest from multiple bilateral rib fractures that occurred when his vehicle was blown over in a wind storm. He underwent open reduction with internal fixation (ORIF) of the bilateral rib fractures and they successfully healed. However, he had permanent long thoracic nerve injury on the side with the most severe trauma. This resulted in symptomatic scapular winging that impeded him from long-distance truck driving. The scapular winging was surgically corrected nearly two years later with a pectoralis major transfer augmented with fascia lata graft. The patient had an excellent final result.
  
  
  CONCLUSIONS
  We report this case to alert surgeons who perform rib fracture ORIF that long thoracic nerve injury is a potential iatrogenic complication of that procedure or might be a result of the chest wall trauma.
  
  
  CONCLUSIONS
  Although the specific cause of the long thoracic nerve injury could not be determined in our patient, it was associated with chest wall trauma in the setting of rib fracture ORIF. The scapular winging was surgically corrected with a pectoralis major transfer.
authors.affiliation: The University of Utah, Department of Orthopaedic Surgery, Salt Lake City, UT, USA; Utah Orthopaedic Specialists, Salt Lake City, UT, USA; Intermountain Medical Center, Salt Lake City, UT, USA. Electronic address: jskedrosmd@uosmd.com.
authors.forename: John G
authors.initials: JG
authors.lastname: Skedros
authors.affiliation: Utah Orthopaedic Specialists, Salt Lake City, UT, USA. Electronic address: chadmears330@gmail.com.
authors.forename: Chad S
authors.initials: CS
authors.lastname: Mears
authors.affiliation: Utah Orthopaedic Specialists, Salt Lake City, UT, USA. Electronic address: tannerlangston1@gmail.com.
authors.forename: Tanner D
authors.initials: TD
authors.lastname: Langston
authors.affiliation: Intermountain Medical Center, Salt Lake City, UT, USA. Electronic address: Don.vanboerum@imail.org.
authors.forename: Don H
authors.initials: DH
authors.lastname: Van Boerum
authors.affiliation: Intermountain Medical Center, Salt Lake City, UT, USA. Electronic address: tom.white@imail.org.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: White
keywords: Medial; Pectoralis major transfer; Rib fractures; Rib plating; Scapular; Winging