title: Pilot study of sternal plating for primary closure of the sternum in cardiac surgical patients.
abstract: OBJECTIVE
  Postoperative sternal wound complications are a significant problem in high-risk patients. In addition to closure with conventional wires, several systems involving rigid fixation with metal plates are currently available. The rapid sternal closure system (Talon) is approved for stabilization and fixation of the anterior chest wall. Anecdotal evidence suggests that use of the Talon may result in improved postoperative recovery.
  
  
  METHODS
  Fifty-one cardiac surgical patients at higher risk for sternal wound complications were enrolled at two sites. Subjects were randomized to insertion of Talons (n = 28) or wires only (control, n = 23) for sternal closure. The primary endpoint was a comparison between study groups of the percent of baseline incentive spirometry volume through postoperative day 7. Secondary endpoints included other measures of quality of recovery, sternal wound infection, and nonunion.
  
  
  RESULTS
  The percentage of preoperative incentive spirometry volume achieved was higher in the Talon arm (67% ± 32%) versus control (58% ± 24%); however, this was not statistically significant (P = 0.41). Use of the Talon was associated with decreased use of opiates (21.3 ± 11.8 vs. 25.4 ± 21.6 mg, P = 0.44), increased ability to ambulate 1000 ft on postoperative day 5 (25% vs. 13%, P = 0.28), and decreased duration of mechanical ventilation (median 0.5 vs 1.0 days, P = 0.24) and hospital length of stay (4.5 ± 3.2 vs. 5.3 ± 4.0 days, P = 0.40). One superficial sternal wound infection was observed in each study arm. There were no cases of nonunion.
  
  
  CONCLUSIONS
  In this pilot study, the primary endpoint was not statistically different between the treatment groups. Use of the Talon was associated with trends toward benefit in endpoints consistent with enhanced postoperative recovery, highlighting a need for additional data from larger randomized trials.
authors.affiliation: From the *Duke Clinical Research Institute, Duke University, Durham, NC USA; †Department of Anesthesiology and ‡Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC USA; and §Oklahoma Heart Institute, Hillcrest Medical Center, Tulsa, OK USA.
authors.forename: Elliott
authors.initials: E
authors.lastname: Bennett-Guerrero
authors.forename: Barbara
authors.initials: B
authors.lastname: Phillips-Bute
authors.forename: Peter M
authors.initials: PM
authors.lastname: Waweru
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Gaca
authors.forename: James C
authors.initials: JC
authors.lastname: Spann
authors.forename: Carmelo A
authors.initials: CA
authors.lastname: Milano