Biomechanical Comparison of Median Sternotomy Closures

J. E. Losanoff, Collier, A. D., Collette, C. Wagner-Mann, Richman, B. W., Huff, H., Hsieh, F. H., Diaz-Arias, A. & Jones, J. W.
Departments of Surgery, Pathology, Biological Engineering & Psychiatry, University of Missouri-Columbia, USA

Experimental Purpose

Poor healing of median sternotomy can significantly increase morbidity, mortality, and hospital costs.  Reliable sternal fixation is required for effective union.  Although wire has proven the most reliable and widely used sternotomy closure material, no research studies have compared a large variety of wiring techniques in a human model.  With the use of cadaveric human sterna, an easily reproducible experimental model was developed at the University of Missouri-Columbia which compared several wiring methods to assess closure strength and stability.

Research Methods

Fifty-three fresh adult human cadaveric sternal plates with adjacent ribs were fixed with specially designed spiked stainless steel clamps and attached to a TA.HD Texture Analyser.  The texture analyser was used to assess stiffness and displacement using perpendicular repetitive variable force loads of 800 Newtons cycling at a rate of 0.5mm/s.  A range of closures were assessed including single peristernal and transsternal, figure-eight peristernal, figure-eight pericostal, and Robicsek closures using a no.5 stainless steel wire.

TA.HD Proves Valuable for Closure Testing

This novel model of sternotomy closure testing was reliable, inexpensive, and easily reproducible.  The mechanical stability of peristernal and alternating peristernal and transsternal wires was significantly greater than that of the other tested methods and pericostal figure-eight closures were found to be insufficiently stable to be considered a reliable method of primary sternotomy repair.

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