Traumatic Clamshell Thoracotomy Closure Using Plates and Screws - a New Look for a Challenging Exposure: A Pilot Study

Authors

• Zachary M. Bauman, Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. Electronic address: zachary.bauman@unmc.edu.
• Quentin McIlvaine, Lake Erie College of Osteopathic Medicine, Erie, PA, USA. Electronic address: QMcIlvaine80422@med.lecom.edu.
• Ndidi Ude, Division of Acute Care Surgery, Department of Surgery, Grady Memorial Hospital, Atlanta, GA, USA. Electronic address: Nude@msm.edu.
• Jonathan Nguyen, Division of Acute Care Surgery, Department of Surgery, Grady Memorial Hospital, Atlanta, GA, USA. Electronic address: jnguyen@msm.edu.
• Sarah Ann Whitbeck, Chief Executive Officer - Chest Wall Injury Society, Salt Lake City, UT, USA. Electronic address: sarahann@cwisociety.org.
• Dávid Sütöri, Aladar Petz University Teaching Hospital, Gyor, Vasvari Pal str. 2-4 9024, Hungary. Electronic address: david.sutori@gmail.com.
• Vincent Athas, University of Louisville - School of Medicine, Division of Surgical Critical Care and Acute Care Surgery, Department of Surgery, Louisville, KY, USA. Electronic address: vincent.athas@louisville.edu.
• Jacqueline Seoane, University of Louisville - School of Medicine, Division of Surgical Critical Care and Acute Care Surgery, Department of Surgery, Louisville, KY, USA. Electronic address: jacqueline.seoane@louisville.edu.
• Constantine Saites, Cascade Trauma and Acute Care Surgery, Tacoma, WA, USA. Electronic address: Constantine.Saites@ctacshealth.org.
• Veronica Bustillo-Aruca, Cascade Trauma and Acute Care Surgery, Tacoma, WA, USA. Electronic address: Veronica.Bustillo-Aruca@ctacshealth.org.
• Ilya Shnaydman, Section of Trauma and Acute Care Surgery, Westchester Medical Center, New York Medical College Department of Surgery, Valhalla, NY, USA. Electronic address: Ilya.Shnaydman@wmchealth.org.
• Jordan M. Kirsch, Section of Trauma and Acute Care Surgery, Westchester Medical Center, New York Medical College Department of Surgery, Valhalla, NY, USA. Electronic address: jordanmkirsch@gmail.com.
• Thomas W. White, Division of Trauma and Critical Care Surgery, Department of Surgery, Intermountain Medical Center, Salt Lake City, UT, USA. Electronic address: tom.white@imail.org.

Author Type(s)

Faculty

DOI

10.1016/j.injury.2025.112847

Journal Title

Injury

First Page

112847

Document Type

Article

Publication Date

1-1-2026

Department

Surgery

Keywords

Clamshell thoracotomy, Closure, Functional status, Rib fixation, Sternal fixation

Disciplines

Medicine and Health Sciences

Abstract

BACKGROUND: The clamshell thoracotomy (CST) is a rare, but lifesaving procedure often performed in austere environments. The closure of a CST is challenging and can be fraught with post-operative complications/failure resulting in debilitating chest wall instability. The recent advent of rib and sternal fixation hardware has provided additional tools possibly offering better ways to close a CST. The objective of this study was to examine the use of plates and screws to close CSTs, hypothesizing it is safe and effective, providing good functional outcomes. METHODS: This was a multi-institutional, international, retrospective review of patients undergoing CST closure with plates and screws utilized in rib/sternal fixation. Exclusion criteria included patients that died prior to hospital discharge. Exact methods for closure were left to the discretion of the operating surgeon, however plates and screws were the main foundation. Basic demographics were obtained. Outcomes of interest included number of plates used, days to closure, complications post-operatively, length of follow-up, and post-operative functional status (1=worst functional status; 5=best functional status). Descriptive statistics were reported. RESULTS: Nineteen patients from 7 centers were included. Two patients were excluded as they died inpatient. Of the remaining 17 patients, mean age was 34.6 (±18.8) years and 82.4 % were male. 35.3 % percent were white, 41.2 % were black, and 23.5 % were Hispanic. 82.4 % suffered penetrating trauma. Median number of plates used per patient was 1 (Interquartile range (IQR) 1,3). Median time to closure was 1 day (IQR 1,2). Four patients (23.5 %) experienced post-operative complications. Mean follow-up was 197.4 (±206.4) days with all patients obtaining satisfactory chest x-rays during this time. Median functional status reported by patients at follow-up was 4 (IQR 3,5). CONCLUSION: Clamshell thoracotomy closure with plates and screws appears to be safe and effective. Most patients reported favorable long-term functional status. LEVEL OF EVIDENCE: Level V, Therapeutic/care management.

Recommended Citation

Bauman, Z. M., McIlvaine, Q., Ude, N., Nguyen, J., Whitbeck, S. A., Sütöri, D., Athas, V., Seoane, J., Saites, C., Bustillo-Aruca, V., Shnaydman, I., Kirsch, J. M., & White, T. W. (2026). Traumatic Clamshell Thoracotomy Closure Using Plates and Screws - a New Look for a Challenging Exposure: A Pilot Study. Injury, 57 (1), 112847. https://doi.org/10.1016/j.injury.2025.112847