Original article
General thoracic
Mid-Term Results After Sternal Reconstruction Using Titanium Plates: Is It Worth It to Plate?

https://doi.org/10.1016/j.athoracsur.2018.01.057Get rights and content

Background

Sternal dehiscence after median sternotomy is a challenging problem in situations of frail bone, fractures, or complete sternectomy. Plate osteosynthesis offers a promising approach to restore sternal integrity. However, there is only scarce data on mid-term outcome.

Methods

Mid-term data on 34 patients with unstable thorax after open heart operation, requiring sternal refixation with the Synthes Titanium Sternal Fixation System (Oberdorf, Switzerland) between 2005 and 2011, were analyzed. The Titanium Sternal Fixation System was used if conventional rewiring had failed or if failure of rewiring was expected because of risk factors. Follow-up examinations included clinical tests, computed tomographic scans, and pain assessment to evaluate sternal integrity and persistent pain.

Results

Median follow-up time was 1.4 years (range, 0.3 to 6.6 years). Clinical examination showed thoracic stability in all patients. Computed tomographic scans demonstrated complete bone consolidation in 25.8%, nearly complete in 38.7%, partial in 9.7%, and missing in 25.8% of patients. Pain assessment revealed no sternal pain in 16 patients (48.5%), mild pain in 9 (27.3%), moderate pain in 3 (9.1%), and severe pain in 5 patients (15.1%). Pain on movement was reported in 12 patients and 5 patients had chronic pain. A total of 13 patients (38%) required plate removal due to pain (n = 8) or infection (n = 5) after a median of 10.9 and 2 months, respectively.

Conclusions

With the use of plates, it was possible to achieve thoracic stabilization in complicated dehiscence. However, the rate of postoperative infection and pain is not negligible. Thus, we recommend plate reconstruction only in sternal high-risk patients, who are unsuitable for standard reclosure.

Section snippets

Synthes TSFS

The system consists of titanium unilock screws and different locking plates (eg, sternal body plates, star-shaped, H-shaped plates, straight plates). Depending on the sternal fracture line, we used the TSFS in a transverse (n = 21) or a longitudinal (n = 13) orientation. Sternal H-shaped, angle-shaped, or star-shaped plates (sternal body plates) were used to treat a separation of the manubrium or the xiphoid (n = 4) (Fig 1A).

In situations of complete sternal dehiscence, different sternal body

Results

Between 2005 and 2011, a total of 34 patients (mean age, 64 ± 11 years, 26 men) with complicated sternal dehiscence underwent sternal refixation with the use of the TSFS at the German Heart Centre Munich. Prior sternotomy had been performed for coronary artery bypass grafting (CABG; n = 15), CABG and concomitant valve procedures (n = 5), aortic or mitral valve operation (n = 11), and others (n = 3). The initial heart operation was performed 8 to 2,373 days (median, 99 days) before sternal plate

Comment

Previously, the superiority of mechanical stabilization of sternal plate ostesynthesis over sternal wire fixation has been demonstrated in animal studies 16, 17. From the hypothesis that increased stability may facilitate the recovery of high-risk patients undergoing cardiac operation, the adoption of rigid fixation gained importance as an effective method for sternal re-stabilization 8, 9, 11, 13. One of the most widely used systems for the treatment of complicated sternal dehiscence is the

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