Rigid Fixation of the Sternum Using a New Coupled Titanium Transverse Plate Fixation System

Abstract

Restoration of sternal integrity after median sternotomy for cardiac interventions better ensures optimal postoperative pulmonary function and minimizes overall morbidity. Sternal dehiscence or nonunion mitigates against such a successful outcome. Under such circumstances, if enough viable and uninfected sternum remains, an anatomic reduction should be attempted. Rewiring usually proves unsuccessful, and rigid plate fixation is more rewarding. A new titanium sternal fixation system that permits transverse orientation of plates has been used in 4 patients who had sterile complete or imminent sternal dehiscence to allow eventual sternal union. The specific advantage of this new system is the presence of a releasing pin in the center of coupled plates to allow rapid chest reentry if required without the specific need for cumbersome plate removal. One patient had delayed removal of an infected plate after sternal union was achieved.

Sternal reconstruction with titanium plates in complicated sternal dehiscence

“…Cicilioni et al [6], a plastic surgeon, described plate removal in 8% of a group of 50 patients treated with transverse plate fixation. Hallock and Szydlowski [16] had to remove the transverse plates in one of four patients (25%). This complication was not seen in patients with longitudinally placed plates.…”

“…In this case the sternal halves have to be approximated by two forceps before transverse plating. We avoid using forceps because of the risk of injury as described above [16]. As part of our standard technique in sternal refixation, we are used to dissecting the sternal border to remove any fibrous tissue and thus to promote firm healing of the bone.…”

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

“…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.…”

“…Providing a more stable osteotomy and improving sternal osteosynthesis is the best way to prevent these complications [3,4,27,28] . More than 40 different techniques with various materials have been described for sternal closure [12][13][14][15][16] . Most techniques revolve around a different pattern of wire cerclage, rigid plate fixation, or various non-rigid methods of closure [29][30][31][32][33][34][35][36] .…”

“…Providing greater stability [3,4,6] and promoting primary osseous healing is crucial for preventing these complications [7][8][9][10][11] . More than 40 different techniques have been described for closing median sternotomy [12][13][14][15][16] . The biomechanical characteristics of different sternal closures may substantially improve sternotomy reduction and stability [17][18][19] .…”