Awake sternal fixation; comparison of technical details and early results with sternal fixation methods performed via general anaesthesia

Abstract

OBJECTIVES Isolated sternal fractures are rare pathologies that rarely require surgical fixation. Although different fixation techniques are used, it is routinely performed under general anaesthesia. In our study, we aimed to share the details of the awake sternal fixation technique performed in our clinic and to compare the early results with sternal fixation methods performed under general anaesthesia. METHODS Between January 2009 and January 2023, 129 patients who were diagnosed with sternal fracture and who underwent investigations and follow-up in our clinic were evaluated retrospectively. Thirteen patients who underwent surgical fixation for isolated sternal fracture were included in the study. Patients were categorized according to fixation and anaesthetic technique; Group 1: fixation with steel wire under general anaesthesia (n = 4), Group 2: fixation with titanium plate-screw under general anaesthesia (n = 4), Group 3: fixation with awake titanium plate-screw with parasternal intercostal plane block (n = 5). Demographics, surgical indication, radiological findings, surgical incision, surgical time and hospital stay were statistically compared. RESULTS The mean age of the patients included in the study was 55.15 ± 15.01 years and 84.6% (n = 11) were male. The most common reason for fixation was displaced fracture (53.8%). Fixation surgery was performed due to pain in 30.8% (n = 4) and non-union in 15.4% (n = 2) of the fractures. The mean duration of surgery were 98.75 ± 16.52, 77.5 ± 35 and 41 ± 14.74 min respectively. Duration of surgery was significantly lower in Group 3 compared to the other groups (p = 0.012). The hospital stay duration for group 1 was 6 days, group 2 was 4 days, and group 3 was 1 day. A notable difference was observed among all groups (p = 0.019). CONCLUSIONS Awake sternal fixation technique with titanium plate screw system under superficial parasternal intercostal plane block is an easy and effective method for surgical treatment of isolated sternal fractures. This technique showed a direct positive effect on the duration of surgery and hospital stay.