Comparison of straight median sternotomy and interlocking sternotomy with respect to biomechanical stability

Abstract

AIM:To increase the stability of sternotomy and so decrease the complications because of instability. METHODS:Tests were performed on 20 fresh sheep sterna which were isolated from the sterno-costal joints of the ribs. Median straight and interlocking sternotomies were performed on 10 sterna each, set as groups 1 and 2, respectively. Both sternotomies were performed with an oscillating saw and closed at three points with a No. 5 straight stainless-steel wiring. Fatigue testing was performed in craniocaudal, anterio-posterior (AP) and lateral directions by a computerized materials-testing machine cycling between loads of 0 to 400 N per 5 s (0.2 Hz). The amount of displacement in AP, lateral and craniocaudal directions were measured and also the op- posing bone surface at the osteotomy areas were calculated at the two halves of sternum. BRIEF ARTICLE RESULTS:The mean displacement in cranio-caudal direction was 9.66 ± 3.34 mm for median sternotomy and was 1.26 ± 0.97 mm for interlocking sternotomy, P < 0.001. The mean displacement in AP direction was 9.12 ± 2.74 mm for median sternotomy and was 1.20 ± 0.55 mm for interlocking sternotomy, P < 0.001. The mean displacement in lateral direction was 8.95 ± 3.86 mm for median sternotomy and was 7.24 ± 2.43 mm for interlocking sternotomy, P > 0.001. The mean surface area was 10.40 ± 0.49 cm² for median sternotomy and was 16.8 ± 0.78 cm² for interlocking sternotomy, P < 0.001. The displacement in AP and cranio-caudal directions is less in group 2 and it is statistically significant. Displacement in lateral direction in group 2 is less but it is statistically not significant. Surface area in group 2 is significantly wider than group 1. CONCLUSION:Our test results demonstrated improved primary stability and wider opposing bone surfaces in interlocking sternotomy compared to median sternotomy. This method may provide better healing and less complication rates in clinical setting, further studies are necessary for its clinical implications.

Histopathological comparison of bone healing effects of endonasal and percutaneous lateral osteotomy methods in rabbit rhinoplasty model

“…Likewise, Kucukdurmaz et al reported that a small, non-zigzag-shaped osteotomy was superior to plain osteotomy. 15 Sinha et al compared the postoperative effects of endonasal and percutaneous osteotomy techniques during rhinoplasty in 45 patients. Endonasal osteotomy has been reported to cause ecchymosis, edema and hemorrhage more frequently when compared to percutaneous lateral osteotomy.…”

Straight versus S-shaped sternotomy: a histologic study in the sheep model

“…Kucukdurmaz et al found that interlocking sternotomy (a zigzag cut in three dimensions) is superior to those of the straight median sternotomy [19]. The zigzag cuts made the sternotomy line significantly more stable and provided more surface area for bony healing.…”

Quality of life in patients undergoing minimally invasive cardiac surgery: a systematic review

“…These complications include mediastinitis in 0.3 to 5% of patients, with a mortality rate of 14 to 47% [ 1 ]. Since the sternum is divided, sternal instability is another possible complication, which is the leading cause of postoperative morbidity and mortality [ 2 , 3 ]. These complications can result in a prolonged hospital stay and subsequently a higher healthcare cost [ 4 , 5 ].…”