1. Novel Repair of Disruption of the Costal Margin without associated Diaphragmatic Hernia Renée M. Tholey, Christine E. Feldmeier, Michael J. Walker Eastern Cardiothoracic Surgery Society Annual Meeting October 23-26, 2013

2. Patient Case Presentation We present a case of a 58 year old man with right- sided rib pain and shortness of breath following a fall on his left side. On physical exam there was an obvious disruption of the right anterior costal margin with a large separation between the eighth and ninth ribs causing chest wall instability.

3. Patient Case Presentation CT Chest demonstrated a herniation of lung between the eighth and ninth ribs. There was no evidence of a diaphragmatic hernia.

4. Patient Case Presentation Our patient was taken to the operating room where a novel technique was used to re-approximate and stabilize the eighth and ninth ribs by employing two Sternal Talon ® devices.

5. Patient Case Presentation We put forth this case report as both a rare occurrence of costal margin disruption in the absence of diaphragmatic hernia, as well as a novel and never-reported technique to repair this abnormality. Stabilization of the patients chest wall provided relief of his pain, as well as improved lung mechanics.