Repair of transverse sternal nonunions using metal plates and autogenous bone graft

Bertin, Kim C; Rice, Robert S; Doty, Donald B.; Jones, Kent W.

doi:10.1016/s0003-4975(02)03400-8

Cited by 47 publications

(47 citation statements)

References 6 publications

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“…Although vertical sternal nonunion has been seldom reported, transverse nonunion may be more commonly associated with the partial sternotomy due to the fragmented sternal interface created by this method (3). Valid and valuable techniques and materials have been developed for securing the sternotomy fixation including modifications of sternal wiring method or invention of new sternal fixation device (3)(4)(5)(6). Most of them are focused on the materials or methods for the extrinsic reinforcement.…”

Section: Discussionmentioning

confidence: 99%

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Intramedullary reinforcement of sternal fixation with autologous xiphoid tenon

Chang

2018

J. Thorac. Dis.

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Minimally invasive cardiac surgery through a partial sternotomy or a ministernotomy is popular. However, the transverse nonunion of the sternum will be a potential complication. Valid and valuable techniques have been introduced for securing the sternotomy fixation. Most of them are focused on the materials or methods for extrinsic reinforcement. A new concept, focused on the intramedullary reinforcement of the sternal fixation, was designed by incarcerating a cancellous portion of the autologous xiphoid in the marrow space of the inter-segmental junction of the partial sternotomy. This autologous xiphoid tenon method is simple, reliable, and reproducible without additional requirement of device implantation or an iliac incision for the bone grafting.

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Section: Discussionmentioning

confidence: 99%

“…However, it exposes a patient to the potential risk of transverse sternal nonunion (3). Valid and valuable techniques and materials have been developed for securing the sternotomy fixation (3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Intramedullary reinforcement of sternal fixation with autologous xiphoid tenon

Chang

2018

J. Thorac. Dis.

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“…Obtaining strong, safe fixation is challenging. These problems can be overcome to some extent by the use of screws with decreased pitch and increased thread depth [20,21].…”

Section: Discussionmentioning

confidence: 99%

Orthopaedic anatomy of the sternum: A micro-CT study to guide the fixation of sternal fractures

Lindner¹,

Douglas²,

Seligson³

et al. 2017

Biol Eng Med

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“…The vast majority of these non-unions occur following median sternotomies and are therefore vertical nonunions. 1 More recently, due to the trend towards minimally invasive approaches to the heart, partial sternotomies have been performed and non-union of these reported. 2 Traumatic fracture of the sternum normally results in a transverse fracture, and only rarely causes long-term symptoms.…”

Section: Discussionmentioning

confidence: 99%

Open reduction and internal fixation of a non-united transverse sternal fracture

Hoschtitzky

Khalid

et al. 2005

Injury Extra

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A 60-year-old male crane-driver slipped at work and fell onto his anterior chest against a concrete bar. This caused a transverse fracture of the body of his sternum. The pain in his anterior chest wall and sternum caused him such severe pain that, 4 months after the injury he was still taking daily morphine derivatives and was unable to work. On examination, he had a very painful and tender area at the site of the fracture, with mobility and crepitus. Sternal radiographs showed a transverse, posteriorly displaced fracture of the body of the sternum with fibrous non-union of the fracture plane ( Fig. 1). He was therefore referred to a thoracic surgeon for advice regarding surgical management of his sternum.The fracture was exposed through a paramedian skin incision, so that the wound would not be directly over the plate. The chest wall muscles were elevated from their insertion onto the sternum. The transverse sternal fracture, which was located towards the upper half of the body of the sternum, was exposed and the fibrous non-union carefully taken down by a combination of sharp dissection with a No. 15 blade and a Volkmann's spoon. Despite this it was not possible to safely mobilise the bone ends enough to allow end-to-end apposition without damage to the soft bone. Approximately 3-4 mm of the distal fragment was therefore excised. This allowed for satisfactory reduction of the fracture with a bone clamp (Fig. 2).Using an aluminium template, a seven-hole reconstruction plate was chosen and contoured. This allowed for three holes above and three holes below the fracture line. The three proximal holes for 4 mm cancellous screws were pre-drilled, measured and partially tapped using the definitive plate as a guide. A bone lever was placed posteriorly to the bone to protect the deep structures during this procedure. The plate was then fixed to the proximal fragment and then the fracture reduced and held with a bone clamp. The distal screws were then inserted. Iliac crest cancellous bone autograft chips were laid alongside the plate. A lateral sternal radiograph confirmed the correct position of the plate, appropriate length of the screws, and a complete reduction of the fracture. The soft tissues were closed over a redivac drain and the skin closed with a subcuticular undyed 3-0 Vicryl 1 . The skin was closed with clips. The patient was not Injury Extra (2005) 36, 214-216

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Repair of transverse sternal nonunions using metal plates and autogenous bone graft

Cited by 47 publications

References 6 publications

Intramedullary reinforcement of sternal fixation with autologous xiphoid tenon

Intramedullary reinforcement of sternal fixation with autologous xiphoid tenon

Orthopaedic anatomy of the sternum: A micro-CT study to guide the fixation of sternal fractures

Open reduction and internal fixation of a non-united transverse sternal fracture

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