title: Comparison of straight sternotomy and interlocking sternotomy in open heart surgery.
abstract: OBJECTIVE
  Stable sternal approximation is an important factor to avoid respiratory complications after open heart surgery. The present study is designed to compare interlocking sternotomy and straight sternotomy in terms of sternal stability, pain and respiratory function.
  
  
  METHODS
  Sixty patients scheduled for open heart surgery underwent a standard midline sternotomy (n=30) or an interlocking sternotomy (n=30). The features assessed were pain on visual analogue scale during rest and during cough, peak expiratory flow rate and sternal instability. Evaluation was performed on the first, fourth post-operative days, on discharge and one month and three month follow up.
  
  
  RESULTS
  Analysis of the peak expiratory flow rates, visual analogue ratings of pain intensity at rest and on coughing were carried out for each group only for those patients who completed the study. Postoperatively, in all patients there was significant reduction in peak expiratory flow rates. In the straight sternotomy group resting pain intensity was higher on discharge (2.6+/- 2 vs 1.6 +/- 2.3, P= 0.005). In the interlocking sternotomy group pain on coughing was significantly less than straight sternotomy group (median 0.5 vs 2.8, P=0.005) at 1 month follow up and at 3 months (median 0 vs 1.6, P=0.003).
  
  
  CONCLUSIONS
  Interlocking sternotomy can be performed with good functional results and offers a less painful alternative to straight sternotomy.
authors.affiliation: Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Kushal
authors.initials: K
authors.lastname: Madan
authors.forename: Vishwa Prakash
authors.initials: VP
authors.lastname: Gupta
authors.forename: Rajvir
authors.initials: R
authors.lastname: Singh
authors.forename: Sachin
authors.initials: S
authors.lastname: Talwar
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Choudhary
authors.forename: Balram
authors.initials: B
authors.lastname: Airan
authors.forename: A
authors.initials: A
authors.lastname: Sampath Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D010366:Peak Expiratory Flow Rate; D013249:Sternum / Q000601:surgery*