Abstract Background 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. Objectives This study aimed to assess the incidence, clinical evolution, and radiologic characteristics of bicorticality in a prospective cohort of RibXcar patients. Methods 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). Results 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. Conclusions 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.
Cipriani et al. (Sun,) studied this question.