PMC6260384_01
Planning for Localization. (A) Screenshot of the planning software with visualization of all targets during inspiration (green dots) and expiration (grey dots). Each individual rib fracture site is marked as a target prior to viewing this summary screen. There is 2.2 cm displacement of the rib between inspiration and expiration. (B) Screenshot of the planning software for localization of the rib fracture on the skin using the SPiN Perc . An entry site on the skin is placed perpendicular to the site of the rib fracture.
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The software demonstrated 2.2 cm rib fracture displacement between inspiration and expiration (Fig. 1A). Next, we identified the skin that was directly superficial to the site of the fractured ribs using the SPiN Perc  protocol (Fig. 1B).
Intra-operative Localization. (A) Photograph of the bronchoscopy screen on the left and the electromagnetic navigation screen on the right correlating the bronchoscopy of carina to software-generated carina to match the computed tomographic (CT) image to the patient. (B-C) Photograph of real time localization using SPiN Perc  software to mark the location of the fracture on the skin. The needle tip (B) is moved to the corresponding spot seen on the software screen (C). (D) Photograph of the skin after localization. (E) Photograph of the needle through the skin accurately locating the rib fracture. (F) Chest X-ray after rib fixation using the MatrixRIB plating system.
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Intraoperatively, a bronchoscopy was performed for electromagnetic calibration (Fig. 2A). Then, cutaneous sites of all fractures were identified and marked with image guidance (Fig. 2B-C). The rib fractures were readily identified with accurate correlation with the cutaneous sites (Fig. 2D). The fractures were freed from the bony callus and were fixed with MatrixRIB plates (DePuySynthes, West Chester, PA, USA) in a conventional fashion (Fig. 2E).