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Related Concept Videos

The Thoracic Cage: Sternum01:17

The Thoracic Cage: Sternum

The thoracic or rib cage forms the body's thorax (chest) portion. Its primary function in the body is to protect vital organs in the thoracic cavity, such as the heart and the lungs. It consists of 12 pairs of ribs with their costal cartilages and the sternum. The ribs are anchored posteriorly to the 12 thoracic vertebrae (T1-T12).
The sternum is the elongated bony structure on the anterior side of the thoracic cage. It consists of three parts: the manubrium, the body, and the xiphoid process.
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Related Experiment Video

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Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling
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Sternal force distribution during median sternotomy retraction.

Philipp Aigner1, Farsad Eskandary, Thomas Schlöglhofer

  • 1Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria.

The Journal of Thoracic and Cardiovascular Surgery
|October 1, 2013
PubMed
Summary

Sternal retractor shape significantly impacts force distribution during cardiac surgery. Curved retractors concentrate force centrally, while straight retractors apply more force to the sternum's edges.

Keywords:
40.240.3CSRSSRcurved sternal retractorstraight sternal retractor

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Area of Science:

  • Biomedical Engineering
  • Surgical Instrumentation
  • Thoracic Surgery

Background:

  • Median sternotomy is standard for cardiac surgery.
  • Sternal retractors can cause significant thoracic cage damage due to applied forces.
  • Understanding force distribution is crucial for designing safer retractors.

Purpose of the Study:

  • To investigate the effect of sternal retractor shape on local force distribution.
  • To establish design criteria for improved sternal retractors.

Main Methods:

  • Two retractor types (straight [SSR] and curved [CSR]) were instrumented with force sensors.
  • Force distribution, total force, and displacement were measured in 18 human cadavers.
  • Measurements were taken up to 10 cm spread width across 4 iterative cycles.

Main Results:

  • Maximum total forces for full retraction were similar for both retractor types.
  • Straight retractors (SSR) applied higher forces to the cranial and caudal sternum.
  • Curved retractors (CSR) concentrated higher forces on the median sternal section.
  • Average force decreased across iterative spreading cycles.

Conclusions:

  • Sternal retractor blade shape critically influences force distribution on the sternum.
  • SSR design leads to higher forces at the sternal edges.
  • CSR design results in maximal forces at the sternal midline.