Wandering wires: frequency of sternal wire abnormalities in patients with sternal dehiscence
P M Boiselle1, A V Mansilla, M S Fisher
1Department of Diagnostic Imaging, Temple University Hospital, Philadelphia, PA 19140, USA.
Insights
Sternal wire abnormalities, particularly displacement, are common in patients with sternal dehiscence. Radiographic findings often appear before clinical diagnosis, highlighting radiography
Area of Science:
- Radiology
- Thoracic Surgery
- Medical Imaging
Background:
- Sternal dehiscence is a serious complication following median sternotomy.
- Accurate detection of sternal dehiscence is crucial for timely intervention.
- Radiography plays a role in diagnosing postoperative complications.
Purpose of the Study:
- To evaluate the frequency of sternal wire abnormalities on chest radiographs in patients with sternal dehiscence.
- To determine the diagnostic utility of radiography in identifying sternal dehiscence.
Main Methods:
- Retrospective review of chest radiographs from patients diagnosed with sternal dehiscence (1993-1998).
- Comparison of radiographs at diagnosis with initial postoperative images.
- Radiologists assessed sternal wire displacement, rotation, and disruption; control group used for comparison.
Main Results:
- Sternal wire abnormalities were detected in 89% of patients with sternal dehiscence.
- Displacement was the most frequent abnormality (84%), followed by rotation (53%) and disruption (21%).
- Radiographic abnormalities preceded clinical diagnosis in 68% of cases; no abnormalities found in controls.
Conclusions:
- Sternal wire abnormalities, especially displacement, are highly prevalent in sternal dehiscence.
- Radiographic findings frequently precede clinical diagnosis, underscoring radiography's role.
- Chest radiography is a valuable tool for detecting sternal dehiscence.
Objective:
The purpose of this study is to assess the frequency of various sternal wire abnormalities on chest radiographs of patients with sternal dehiscence and to determine the role of radiography in detecting or confirming this complication.
Materials And Methods:
We used our computerized hospital information system to identify all patients with a diagnosis of sternal dehiscence from January 1993 through June 1998. Clinical data were obtained by retrospective chart review. A chest radiograph from the date of diagnosis was compared with the first postoperative radiograph obtained after median sternotomy. Each radiograph was retrospectively reviewed by two radiologists who assessed three sternotomy wire abnormalities: displacement (offset of one or more wires in relation to others in the vertical row), rotation (alteration in the axis of a wire compared with its orientation on a baseline radiograph), and disruption (unraveling or fracture of a wire). We also reviewed a series of postoperative radiographs in a group of matched controls who had an uneventful postoperative course with no clinical evidence of dehiscence.
Results:
The study cohort included 19 patients, 13 men and six women, who were 49-84 years old (mean, 66 years). The chest radiographs revealed sternal wire abnormalities in 17 (89%) of 19 patients with sternal dehiscence, including displacement in 16 (84%) of 19 patients, rotation in 10 (53%) of 19 patients, and disruption in four (21%) of 19 patients. The mean number of displaced wires per patient was 2.3 (range, 1-5). The mean distance of maximal displacement was 20 mm (range, 6-45 mm). Radiographic abnormalities preceded the clinical diagnosis in 13 (68%) of 19 patients. We observed no case of sternal wire displacement, rotation, or disruption in the control group.
Conclusion:
Sternal wire abnormalities, most notably displacement, are present in most patients with sternal dehiscence; radiographic abnormalities precede the clinical diagnosis in most cases.
More Related Videos
10:11Maturation of Human Stem Cell-derived Cardiomyocytes in Biowires Using Electrical Stimulation
Published on: May 6, 2017
15:11Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling
Published on: January 5, 2015
Related Concept Videos
01:25Cardiovascular System Abnormal Findings II: Auscultation
Abnormal Heart Sounds
Gallops:
01:30Pulse rhythm
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac muscle...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:31Respiratory System Abnormal Finding II: Palpation and Auscultation
Palpation Findings
During a respiratory assessment, palpation can reveal several vital abnormalities:
01:29Dysrhythmias III: Characteristics of Dysrhythmias
01:29Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...