Sternal plate closure: indications, surgical procedure and follow-up.
OBJECTIVE
Titanium plate osteosynthesis (Synthes) is an alternative option for sternal closure. The indications and time point of application are still debated. This study investigated the application and feasibility of this technique after median sternotomy.


METHODS
Forty-one patients (29 M/12F, mean age 63 ± 17 years) received the plate system for complicated sternal conditions. Indications, intraoperative course and postoperative follow-up were assessed.


RESULTS
Sternal deformity was present in 5 % (2/41), sternal fractures in 17 % (7/41), bone defect in 12 % (5/41), wire loosening in 39 % (16/41) and pseudoarthrosis in 27 % (11/41). 54 % (22/41) of patients showed concomitant sternal infection. Two intraoperative complications were noted: mammary artery injury (1 patient), pleural injury (1 patient). At discharge the patients reported no pain (90 %, 37/41) or only occasional discomfort (10 %, 4/41). Postoperative complications were subcutaneous hematoma in 12 % (5/41), seroma in 12 % (5/41) and sternal reinfection in 7 % (3/41). 12 % (5/41) showed occasional discomfort and 7 % (3/41) had persistent pain leading to plate removal.


CONCLUSIONS
The Titanium Sternal Fixation System is comfortable and easy to use. It can be used to treat a wide spectrum of indications, especially for pseudoarthrosis, an entity which has not yet received sufficient attention.
Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland. andre.plass@usz.ch
A
A
Plass
M Y
MY
Emmert
M
M
Pilsl
S P
SP
Salzberg
M
M
Genoni
V
V
Falk
J
J
Grunenfelder
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000150:complications / Q000601:surgery*; D001860:Bone Plates; D001864:Bone Wires; D002648:Child; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000209:etiology; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000293:injuries; D008875:Middle Aged; D010994:Pleura / Q000293:injuries; D011542:Pseudarthrosis / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods; D012307:Risk Factors; D049291:Seroma / Q000209:etiology; D056346:Sternotomy / Q000009:adverse effects; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000382:microbiology / Q000601:surgery*; D013536:Suture Techniques; D014025:Titanium; D016896:Treatment Outcome
D014025:Titanium