Sternal plating for primary and secondary sternal closure; can it improve sternal stability?

Area of Science:

• Biomedical Engineering
• Orthopedic Surgery
• Thoracic Surgery

Background:

• Sternal instability and mediastinitis are severe complications following median sternotomy.
• Biomechanical studies suggest rigid plate fixation is superior to wire cerclage for sternal closure.
• This study evaluates if adding plate fixation improves sternal closure stability.

Purpose of the Study:

• To test the hypothesis that sternal closure stability can be improved by adding plate fixation.
• To compare the biomechanical stability of different sternal closure techniques in a human cadaver model.

Main Methods:

• Eighteen human cadavers underwent midline sternotomy.
• Four closure techniques were tested: wires, cables, wires/cables with one plate, and four plates.
• Sternal separation was measured under increasing intrathoracic pressure.

Main Results:

• Sternal closure with plates (one or four) demonstrated significantly higher resistance to separation compared to wires/cables alone.
• The pressure required to achieve 2.0 mm separation increased significantly with the addition of plates.
• Regression analysis confirmed the stability benefits of plate fixation.

Conclusions:

• Transverse sternal plating, using one or four plates, significantly enhances sternal closure stability in a cadaver model.
• Adding a single sternal plate to traditional wiring improves closure strength.
• Sternal plating could be considered for high-risk patients to reduce sternal dehiscence.