Analysis of Bicorticality in a Cohort of Post-RibXcar Patients: A Clinical and Imaging Follow-up Study.

Abstract

RibXcar is a minimally invasive technique for waistline contouring that uses ultrasound-guided monocortical rib fractures to achieve controlled angulation while preserving thoracic stability. Although its safety profile is favorable, bicorticalization fracture extension through both cortices remains a potential complication requiring systematic evaluation. This study aimed to assess the incidence, clinical evolution, and radiologic characteristics of bicorticality in a prospective cohort of RibXcar patients. A prospective cohort of 328 female patients (mean age 28.3 ± 6.7 years; BMI 25.3 ± 1.8 kg/m²) underwent RibXcar between January and December 2023, performed by a single surgeon. Eligible patients were women aged 18-40 years with BMI < 30 kg/m² and visceral fat < 13%. All completed one-year clinical and radiologic follow-up. Postoperative pain, complications, and imaging findings were analyzed using Wilcoxon tests (p < 0.05). Bicorticality occurred in 15 patients (4.6%), mostly within the first 20 postoperative days. Pain was reported by 41 patients (12.5%), but in 7.9% was related to corset misuse rather than fracture status. Bicorticality correlated with higher visceral fat (12.7% ± 0.5 vs. 8.0% ± 0.3; p < 0.001) and longer operative time (48.9 ± 6.3 vs. 43.3 ± 8.3 min; p = 0.01). No hemothorax or pneumothorax occurred. At one year, 98.2% demonstrated satisfactory healing; 1.5% showed callus irregularity; and only one patient (0.3%) had persistent bicorticality. RibXcar achieves controlled monocortical fractures with a low bicorticalization rate and predictable consolidation. Visceral fat and operative duration appear more influential than BMI in complication risk, supporting the technique's safety and reproducibility.