title: Sternal closure with rigid plate fixation versus wire closure: a randomized controlled multicenter trial.
abstract: BACKGROUND
  Rigid bone fixation is the standard of care for all bone reconstructions except that after sternotomy. Sternal reconstruction after median sternotomy using rigid fixation with plates may improve bone healing and reduce pain when compared with wire cerclage.
  
  
  METHODS
  One-hundred forty patients at six centers who were determined preoperatively to be at high risk for sternal wound complications were randomly assigned to sternal closure with rigid plate fixation (n=70) or wire cerclage (n=70). Sternal healing was evaluated at 3 or 6 months by a core laboratory using computed tomography. Pain and function were evaluated at postoperative day 3 through discharge, 3 weeks, 6 weeks, 3 months, and 6 months.
  
  
  RESULTS
  Sternal healing was superior in rigid plate fixation patients at both 3 and 6 months. Mean computed tomography scores in the rigid plate fixation and wire cerclage groups at 3 months were 1.7±1.1 and 0.9±0.8 (p=0.003). At 6 months, the scores were 3.2±1.6 and 2.2±1.1, respectively (p=0.01). At 6 months, 70% of rigid plate fixation patients had achieved sternal union, compared with 24% of conventional wire cerclage patients (p=0.003). Pain scores and narcotic usage were lower in rigid plate fixation patients. Significant differences in pain scores were observed at 3 weeks for total pain (p=0.020) and pain with coughing (p=0.0084) or sneezing (p=0.030). Complication rates were similar in both groups.
  
  
  CONCLUSIONS
  Sternal reconstruction using rigid fixation with plates improved bone healing and reduced early postoperative pain compared with wire cerclage.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Rush University Medical Center, Chicago, Illinois 60612, USA. jai_raman@rush.edu
authors.forename: Jaishankar
authors.initials: J
authors.lastname: Raman
authors.forename: Sven
authors.initials: S
authors.lastname: Lehmann
authors.forename: Kenton
authors.initials: K
authors.lastname: Zehr
authors.forename: Brian J
authors.initials: BJ
authors.lastname: De Guzman
authors.forename: Lishan
authors.initials: L
authors.lastname: Aklog
authors.forename: H Edward
authors.initials: HE
authors.lastname: Garrett
authors.forename: Heber
authors.initials: H
authors.lastname: MacMahon
authors.forename: Brian M
authors.initials: BM
authors.lastname: Hatcher
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wong
mesh_terms: D000368:Aged; D001860:Bone Plates; D001864:Bone Wires; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D056346:Sternotomy / Q000009:adverse effects*; D013249:Sternum / Q000000981:diagnostic imaging / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014945:Wound Healing