title: Sternal plating for the treatment of sternal nonunion.
abstract: BACKGROUND
  Sternal nonunion, defined as sternal pain with clicking, instability, or both for more than 6 months in the absence of infection, is an uncommon complication of median sternotomy. Nonunion is frequently complicated by the presence of multiple transverse fractures, which make simple rewiring inadequate.
  
  
  METHODS
  Six patients with debilitating pain secondary to sternal nonunion were treated with the technique of sternal plating between 1989 and 1995.
  
  
  RESULTS
  Sternal plating corrected sternal instability and provided excellent pain relief in all 6 patients. All patients reported an improved quality of life and were able to resume recreational activities. Two patients have had plate removal for late bursa formation. Sternal healing was complete in both instances.
  
  
  CONCLUSIONS
  Sternal plating, which is based on the tension-band principle, is an effective treatment of sternal nonunion. The technique is applicable to both simple and complex nonunions. The stainless steel plates resist bending stresses, and the cortical bone resists compressive forces. The technique requires minimal dissection of the posterior sternal border, is not circumferential, and provides secure sternal approximation.
authors.affiliation: Division of Cardiothoracic Surgery, Duke University Medical Center 27710, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Hendrickson
authors.forename: K E
authors.initials: KE
authors.lastname: Koger
authors.forename: C J
authors.initials: CJ
authors.lastname: Morea
authors.forename: R L
authors.initials: RL
authors.lastname: Aponte
authors.forename: P K
authors.initials: PK
authors.lastname: Smith
authors.forename: L S
authors.initials: LS
authors.lastname: Levin
mesh_terms: D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D004867:Equipment Design; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000601:surgery; D018583:Pliability; D011788:Quality of Life; D011998:Recreation; D013193:Stainless Steel; D013249:Sternum / Q000601:surgery*; D013314:Stress, Mechanical; D013896:Thoracic Diseases / Q000601:surgery; D013908:Thoracotomy / Q000009:adverse effects*; D014945:Wound Healing
chemical_list: D013193:Stainless Steel