Biomechanical Study of Sternal Closure Using Rigid Fixation Techniques in Human Cadavers

Ozaki, Wayne; Buchman, Steven R.; Iannettoni, Mark D.; Frankenburg, Elizabeth P.

doi:10.1016/s0003-4975(98)00231-8

Cited by 79 publications

(61 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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.…”

Section: Resultsmentioning

confidence: 89%

“…After sternotomy, these forces can interfere with bony healing and cause serious complications [21][22][23] . An unstable sternotomy can increase postoperative sternal pain, which can lead to atelectasis and pneumonia, secondary to a decreased inspiratory effort [9] . Other serious complications related to instability include sternal dehiscence, deep sternal infection, fulminant medistinitis, osteomylelitis, and chronic sternal instability [4,[24][25][26] .…”

Section: Discussionmentioning

confidence: 99%

“…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] .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Küçükdurmaz

Ağır²,

Bezer³

2013

WJO

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Küçükdurmaz

Ağır²,

Bezer³

2013

WJO

View full text Add to dashboard Cite

show abstract

“…Our findings suggest that a minimum of three X-plates are needed to provide adequate fixation along the sternum. Although we improved on the uniformity of the force applied along the length of the sternum over previous methods, 17,24 it is unclear if any of these loading schemes produces a distribution of loads at the midline representing the in vivo state since the native distribution is unknown. Based on our analysis of the stresses in the model sterna in vitro, the load in the xiphoid region seems disproportionately large, indicating that our system may overestimate distraction at the xiphoid.…”

Section: Discussionmentioning

confidence: 99%

“…4 Although motion at the fracture site may be beneficial to healing, 5 the magnitude of acceptable motion is considerably small (<0.2 mm), and contrary evidence shows that motion may delay healing. 2 Consequently, similar fixation plates have been proposed for sternal reapproximation 10,17,19 and have been used successfully in a limited number of clinical cases. 12,20,21 Despite initial clinical success, cardiac surgeons have been slow to adopt rigid plates for sternal fixation due, in part, to a lack of information about how these plates should be used.…”

Section: Introductionmentioning

confidence: 99%

A Mechanical Study of Rigid Plate Configurations for Sternal Fixation

et al. 2007

View full text Add to dashboard Cite

Abstract-Rigid metal plates are a promising alternative to wires for reapproximating the sternum after open-heart surgery due to their potential ability to reduce motion at the wound site and thereby reduce the likelihood of postoperative healing complications. Despite initial clinical success, the use of plates has been limited, in part, by insufficient knowledge about their most effective placement. This study compares the ability of five plate configurations to provide stable closure by limiting sternal separation. Commercially available x-shaped and box-shaped plates were used and combinations of parameters (plate type, location, and number of plates) were investigated in vitro. Lateral distraction tests using controlled, uniform loading were conducted on 15 synthetic sterna and the distractions between separated sternum halves were measured at seven locations. Distractions at the xiphoid, a critical region clinically, varied widely from 0.03 ± 0.53 mm to 4.24 ± 1.26 mm depending on all three plate parameters. Of the configurations tested, three xshaped plates and one box-shaped plate resisted sternal separation most effectively. These results provide the first comparison of plate configurations for stabilizing a sternotomy. However, basic mechanical analyses indicate that sternal loading in vivo is non-uniform; future studies will need to accurately quantify in vivo loading to improve in vitro test methods.

show abstract

Wire‐based sternal closure: MRI‐related heating at 1.5 T/64 MHz and 3 T/128 MHz based on simulation and experimental phantom study

Zheng

Xia

Kainz

et al. 2019

Magnetic Resonance in Med

View full text Add to dashboard Cite

Purpose:The paper investigates factors that affect the RF-induced heating for commonly used wire-based sternal closure under 1.5 T and 3 T MRI systems and clarifies the heating mechanisms. Methods: Numerical simulations based on the finite-difference time-domain method and experimental measurements in ASTM (American Society for Testing and Materials) phantom were used in the study. Various configurations of the wire-based sternal closure in the phantom were studied based on parameter sweeps to understand key factors related to the RF-induced heating. In vivo simulations were further performed to explore the RF-induced heating in computational human phantoms for clinically relevant scenarios. Results: The wire-based sternal closure can lead to peak 1-g averaged spatial absorption ratio of 106.3 W/kg and 75.2 W/kg in phantom and peak 1-g averaged specific absorption rate of 32.1 W/kg and 62.1 W/kg in computational human models near the device at 1.5 T and 3 T, respectively. In phantom, the simulated maximum temperature rises for 15-minute RF exposure are 9.4°C at 1.5 T and 5.8°C at 3 T. Generally, the RF-induced heating will be higher when the electrical length of the device is close to the resonant length or when multiple components are spaced closely along the longitudinal direction. Conclusion: The RF-induced heating related to wire-based sternal closure can be significant due to the antenna effect and capacitive mutual coupling effect related to the specific geometries of devices. K E Y W O R D S antenna effect, capacitive mutual coupling effect, magnetic resonance imaging (MRI), RF-induced heating, wire-based sternal closure 1056 | ZHENG Et al.

show abstract

Biomechanical Study of Sternal Closure Using Rigid Fixation Techniques in Human Cadavers

Cited by 79 publications

References 14 publications

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

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

A Mechanical Study of Rigid Plate Configurations for Sternal Fixation

Wire‐based sternal closure: MRI‐related heating at 1.5 T/64 MHz and 3 T/128 MHz based on simulation and experimental phantom study

Contact Info

Product

Resources

About