Rigid Fixation for the Prevention and Treatment of Sternal Complications

Nazerali, Rahim; Hinchcliff, Katharine M.; Wong, Michael S.

doi:10.1097/sap.0000000000000155

Cited by 35 publications

(30 citation statements)

References 11 publications

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“…A larger scale CT study of living patients with a normal age and equal gender distribution is warranted before areas of greatest screw purchase can be determined with certainty. In addition, the success of preliminary trials of rigid plate fixation for displaced MSJ and other sternal fractures show promise for development of an orthopedic standard for sternal fracture fixation [2,7,10,11,13,14,19].…”

Section: Discussionmentioning

confidence: 99%

“…Rigid plate fixation has been shown to be an effective method of fixation of MSJ and other sternal fractures [2,7,10,11,13,14,19]. Ostensibly, the close proximity of vital organs directly abutting the dorsal surface of the sternum makes substantive bicortical constructs unfeasible.…”

Section: Discussionmentioning

confidence: 99%

“…All comparative studies to date have focused primarily on sternal reduction following median sternotomy. In these studies, plating has been proven to provide lower rates of nonunion and mediastinitis, reduced pain, increased safety, closer sternal approximation, and required minimal soft tissue dissection as compared to cerclage wiring [2,11,12]. Additionally, preliminary studies of plate fixation of MSJ fracture-dislocations have shown low rates of complications and infection, excellent healing, and minimal damage to surrounding structures and vascular supply [10,13,14].…”

Section: Introductionmentioning

confidence: 99%

“…Since then, the anatomy of the sternum and the MSJ has remained essentially unstudied. This can be attributed to a multitude of factors, the most important of which is the historical infrequency of sternal fractures and low complication rates of cerclage wiring following median sternotomy for open thoracic surgery [2]. Today, sternal fractures are believed to be present in 0.64% of all motor vehicle trauma patients [3].…”

Section: Introductionmentioning

confidence: 99%

“…Today, sternal fractures are believed to be present in 0.64% of all motor vehicle trauma patients [3]. Furthermore, sternal fractures are present in 3% to 8% of all blunt force trauma patients [2].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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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show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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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Guidelines for Perioperative Care in Cardiac Surgery

et al. 2019

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nhanced Recovery After Surgery (ERAS) is a multimodal, transdisciplinary care improvement initiative to promote recovery of patients undergoing surgery throughout their entire perioperative journey. 1 These programs aim to reduce complications and promote an earlier return to normal activities. 2,3 The ERAS protocols have been associated with a reduction in overall complications and length of stay of up to 50% compared with conventional perioperative patient management in populations having noncardiac surgery. 4-6 Evidence-based ERAS protocols have been published across multiple surgical specialties. 1 In early studies, the ERAS approach showed promise in cardiac surgery (CS); however, evidence-based protocols have yet to emerge. 7 To address the need for evidence-based ERAS protocols, we formed a registered nonprofit organization (ERAS Cardiac Society) to use an evidence-driven process to develop recommendations for pathways to optimize patient care in CS contexts through collaborative discovery, analysis, expert consensus, and best practices. The ERAS Cardiac Society has a formal collaborative agreement with the ERAS Society. This article reports the first expert-consensus review of evidence-based CS ERAS practices. Methods We followed the 2011 Institute of Medicine Standards for Developing Trustworthy Clinical Practice Guidelines, using a standardized algorithm that included experts, key questions, subject champions, systematic literature reviews, selection and appraisal of evidence quality, and development of clear consensus recommendations. 8 We minimized repetition of existing guidelines and consensus statements and focused on specific information in the framework of ERAS protocols.

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Recent developments in controlling sternal wound infection after cardiac surgery and measures to enhance sternal healing

Pradeep

Rangasamy

Varma

2020

Medicinal Research Reviews

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One of the major risks of cardiac surgery is the occurrence of infection at the sternal wound site. Sternal wound infections are primarily classified into superficial infection and deep sternal wound infection or mediastinitis. A patient is diagnosed with mediastinitis if microorganisms are present in their mediastinal tissue/fluid or with the observation of sternal wound infection during operation and with characteristic symptoms including chest pain, fever, and purulent drainage from the mediastinum. It is usually caused by Staphylococcal organisms in 75.8% of cases and the rest is caused by gram‐negative bacteria. Currently, in cardiac surgery, hemostasis is achieved using electrocautery and bone wax, and the sternum is closed using wire cerclage. Several studies show that bone wax can act as a nidus for initiation of infection and the oozing blood and hematoma at the site can promote the growth of infectious organisms. Many research groups have developed different types of biomaterials and reported on the prevention of infection and healing of the sternum. These materials are reported to have both positive and negative effects. In this review, we highlight the current clinical practices undertaken to prevent infection and bleeding as well as research progress in this field and their outcomes in controlling bleeding, infection, and enhancing sternal healing.

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Rigid Fixation for the Prevention and Treatment of Sternal Complications

Cited by 35 publications

References 11 publications

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

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

Guidelines for Perioperative Care in Cardiac Surgery

Recent developments in controlling sternal wound infection after cardiac surgery and measures to enhance sternal healing

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