Prospective Evaluation of Anterior Aesthetic Rib Cage Remodeling With Osteosynthesis for Lower Anterior Thoracic Prominence

Prospective Evaluation of Anterior Aesthetic Rib Cage Remodeling With Osteosynthesis for Lower Anterior Thoracic Prominence

This prospective single-group study will evaluate anterior aesthetic rib cage remodeling with osteosynthesis (ARCO) in adults with anteroinferior rib prominence or deformity. The procedure modifies and stabilizes ribs 6 through 8. Inferior rib cage perimeter, CT findings, spirometry, intraoperative respiratory variables, BODY-Q Chest scores, and complications will be assessed through 12 months. The primary outcomes are one-year perimeter change and major procedure-related complications.

Participants who meet standardized ARCO eligibility criteria will undergo preoperative chest CT, spirometry, anthropometry, photography, and BODY-Q assessment. During surgery, controlled greenstick remodeling of the selected anterior ribs will be followed by plate osteosynthesis. Peak inspiratory pressure and pulmonary compliance will be recorded before remodeling, during the maneuver, and after fixation, and thoracic ultrasound will assess pleural integrity. Postoperative CT will evaluate angulation, union, and hardware position; spirometry will assess pulmonary function; and standardized perimeter and BODY-Q measurements will assess aesthetic effectiveness. Complications will be actively collected through month 12.

Inclusion Criteria:

• Age 18 to 45 years, or older participants with documented acceptable bone health under the final protocol.
• Prominence, dysmorphia, or contour concern involving the anteroinferior rib cage and judged appropriate for ARCO.
• Preoperative chest CT, spirometry, medical history, and physical examination completed.
• BMI 30 kg/m2 or lower.
• Ability to comply with CT, spirometry, BODY-Q, and clinical follow-up through 12 months.
• Written informed consent

Exclusion Criteria:

• Osteoarticular disease affecting rib integrity or clinically relevant osteoporosis risk.
• Previous major chest surgery or significant thoracic trauma.
• Coagulation disorder, chronic pulmonary disease, or uncontrolled systemic disease.
• Active cancer, short life expectancy, or contraindication to elective surgery.
• Known adverse reaction to the proposed osteosynthesis material.
• Psychiatric condition or body-image disorder that, after specialist assessment when indicated, impairs informed decision-making or realistic expectations.
• Pregnancy or breastfeeding.