A survey of musculoskeletal and aesthetic abnormalities after thoracotomy in pediatric patients

Abstract

Objective: To study the incidence and type of musculoskeletal and aesthetic abnormalities after thoracotomy in children.

Materials and methods: Children below 12 years of age who had undergone thoracotomy for any condition and have at least 2 years follow up were included in the study. Detailed assessment of the patients included: history and general examination, clinical examination of chest and musculoskeletal system, X-ray chest including bilateral shoulders [antero-posterior (AP), lateral, oblique], X-ray whole spine (AP, lateral, right and left side bending AP view).

Results: Fifty-two pateints were recruited. The incidences of various clinically and radiologically assessed musculoskeletal and aesthetic abnormalities observed were: winging of scapula (5.7%), ipsilateral elevation of shoulder (5.7%), fixation of skin cicatrix to bony thorax (7.7%), maldevelopment of pectoral muscles (11.5%), asymmetry of the level of nipples (1.9%), rib fusion (5.7%), crowding of ribs (9.6%), mediastinal shift (3.8%), decreased space available for lungs (3.8%), Scoliosis with Cobb's angle >10(0) (1.9%).

Conclusions: The incidences of musculoskeletal and aesthetic abnormalities after posterolateral thoracotomies in children were low. Longer follow up of patients after thoracotomy is needed to pick up these abnormalities as the children grow.

Keywords: Aesthetic abnormalities; long term follow-up; musculoskeletal abnormalities; thoracotomy in children.

Figure 1

Distribution of cases within each group

Figure 2

Disease distribution in each group of patients. (EATEF- esophageal atresia with tracheo-esophageal fistula; CES – congenital esophageal stenosis; H-TEF- H type tracheo-esophageal fistula; Lung Mets - Lung metastasis)

Figure 3

(a) Cicatrix fixed to bony thorax (b) same patient showing right pectoral muscle maldevelopment

Figure 4

(a) Rib fusion on X-ray chest (white arrow) (b) X-ray chest showing mediastinal shift, rib crowding, ends of excised rib, and space available for lung (SAL) – 92%. X-ray thoracic spine showing scoliosis with Cobb's angle of 150, with convexity toward left at T3 level (White arrow)