Characterizing twist-to-writhe wiring technique for sternal closure following median sternotomy: biomechanical...

Wire fracture during sternal closure following median sternotomy poses significant risks, including sternal dehiscence. This study introduces and evaluates a novel "twist-to-writhe" technique aimed at reducing the risk of wire fracture while maintaining adequate sternal closure.

Ten foam sternum models per group were used and bisected to simulate median sternotomy. Each foam sternal model was closed with five sternal wires using either the twist-to-writhe (experimental) technique or the traditional (control) technique. In the twist-to-writhe method, wire ends that were cleaved were left at 10 centimeters (cm) before twisting with a wire twister. In the traditional method, wire ends were cut to 1 cm before twisting. Compressive forces at several sternal points were measured.

The average compressive forces across four key sternal points were similar between the twist-to-writhe and traditional methods (167.45 ± 5.96 newton (N) vs. 172.92 ± 7.41 N, p = 0.086). No significant differences in force application were observed at the manubrium, upper mid-sternum, lower mid-sternum, or xiphoid process (p > 0.05 for all comparisons).

The twist-to-writhe technique may reduce the incidence of wire fractures without compromising sternal approximation or closure quality. Further clinical validation is needed to confirm these findings.

The online version contains supplementary material available at 10.1007/s12055-026-02177-w.