This is the unofficial web page of the Titanium Rib Project, an FDA-sponsored clinical trial of an investigational surgical implant known as the Titanium Rib.

Robert Campbell, M.D., pediatric orthopedic surgeon and Melvin Smith, MD, pediatric general surgeon at Christus Santa Rosa Health Care created the expandable titanium rib prosthesis in 1989. The device, known as the titanium rib, treats thoracic insufficiency.

Thoracic insufficiency is defined as "the inability of the thorax to support normal respiration or lung growth." In essence, children with medical problems leading to thoracic insufficiency will likely "outgrow" their own lungs, which are unable to grow and develop normally.

Congenital diseases that can lead to thoracic insufficiency include congenital scoliosis with or without vertebral anomalies and/or fused or absent ribs, Jeune's Asphyxiating Thoracic Dystrophy, Jarcho-Levin Syndrome (spondylocostal dysplasia), Pierre-Robin Syndrome, Cerebrocostomandibular Syndrome, Golden-Har Syndrome, and others.  Many patients treated in the Titanium Rib program suffer from these disorders and may also have Spina Bifida (myelomenigocele), VATER syndrome, and a number of other medical conditions.

In many cases, the alternative treatments (if any) are undesirable and have little potential for long-term positive outcome. In fact, those alternatives can even result in greater thoracic compromise. In the past, many children with this condition did not survive into adulthood.

Originally, the titanium rib was designed as the last hope for an infant with severe chest deformity who was not expected to live due to his respiratory insufficiency. The "rib" has since been modified over the years, and has successfully treated dozens of children.

The "rib" is actually a titanium rod with varying curvature, which conforms to the shape of the thoracic cage into which it is being implanted. The rod is placed vertically along the chest wall by attaching each end to natural ribs above and below the site of defect. It will then act as a protective "patch" over areas where ribs are missing. The implanted titanium rod can also apply tension to the spinal column, which can aid in expanding a compressed thorax, and possibly even stimulate growth over time.

In some cases titanium ribs also have the indirect effect of halting the progression of, or even reversing, scoliosis (curvature of the spine). The "ribs" are also used to enlarge small thoraces through a surgical procedure, which involves cutting the ribs along a line down the chest wall leaving a small gap between the points of separation. The titanium rib is then placed vertically along the site, pulling and securing the bony ribs outward to the device, which acts as a brace and distractor. The cut ribs will grow back together filling the gaps with new bone, thus lengthening the ribs and widening the chest. This device is designed so that it may be expanded (elongated) as the child grows through minor surgical procedures about every four to six months depending on individual growth rate. The goal of this prosthetically aided widening of the chest is to facilitate lung growth and to ultimately counteract, prevent or reverse thoracic insufficiency.

Christus Santa Rosa Children's Hospital in San Antonio, Texas is the primary site in the world where this treatment is available. Physicians at two other hospitals have been trained by our titanium rib team:  In August 1999, Boston Children's Hospital in Boston, Massachusetts.  In  September 1999, Pittsburgh Children's Hospital in Pittsburgh, Pennsylvania.  At which time both hospitals performed their first procedure.  Our project is affiliated with the University of Texas Health Science Center in San Antonio, under the Department of Orthopaedics.

To find out more about the Titanium Rib Project please contact us at:

     Titanium Rib Project
     Santa Rosa Children's Hospital
     519 W. Houston St.
     San Antonio, TX  78207

Lori Buegeler, R.N., Clinical Case Manager
Phone (210)704-2374   or   E-mail

Robert M. Campbell, M.D., Principal Investigator
Phone (210)704-2988        

Melvin D. Smith, M.D., Co-Investigator
Phone (210)692-7337

If you have suggestions, questions or comments about this website please direct them to Robert G. Picklesimer, the proud parent of Robert Kenneth Picklesimer, whom received two titanium ribs in 2001. 
Click here to email him.
As of November 04, 2002, we are up to 202 children in the program.
Click here to view information about the "Titanium Rib Family Network".

This Web Site was last updated on November 14, 2002