Sternal closure with rigid plate fixation versus wire closure: a randomized controlled multicenter trial

Area of Science:

• Orthopedic Surgery
• Thoracic Surgery
• Biomaterials Science

Background:

• Rigid bone fixation is standard for bone reconstructions, excluding sternotomy.
• Wire cerclage is the conventional method for sternal closure after median sternotomy.
• Rigid plate fixation offers potential advantages in sternal healing and pain reduction.

Purpose of the Study:

• To compare the efficacy of rigid plate fixation versus wire cerclage for sternal closure in high-risk patients.
• To evaluate differences in sternal healing, pain, and function between the two fixation methods.

Main Methods:

• A randomized controlled trial involving 140 high-risk patients undergoing median sternotomy.
• Patients were assigned to either rigid plate fixation (n=70) or wire cerclage (n=70).
• Sternal healing assessed by CT scans at 3 and 6 months; pain and function evaluated at multiple postoperative time points.

Main Results:

• Rigid plate fixation demonstrated superior sternal healing at 3 and 6 months (p=0.003 and p=0.01, respectively).
• Sternal union achieved in 70% of rigid plate fixation patients vs. 24% of wire cerclage patients at 6 months (p=0.003).
• Lower pain scores and narcotic usage observed in the rigid plate fixation group, particularly at 3 weeks (p=0.020).

Conclusions:

• Rigid plate fixation enhances sternal bone healing and reduces early postoperative pain compared to wire cerclage.
• This method is a promising alternative for sternal reconstruction in patients at high risk for wound complications.
• Outcomes suggest improved patient recovery and functional status with rigid plate fixation.