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In Reply.—I and my coauthors appreciate Dr Brantigan's calling our attention to the article by his father describing the technique of fixing the lower sternum after osteotomy by attaching the seventh costal cartilage to the adjacent fifth rib. This technique may have particular application in adolescent or adult patients who have a longer segment of sternum below the osteotomy and who require some form of rigid fixation. The retrosternal periosteal attachment described in our article is most easily applied to young children who have a relatively short sternum.
FONKALSRUD EW. 'Railroad Track' Operation-Reply. Arch Surg. 1979;114(9):1092. doi:10.1001/archsurg.1979.01370330113026