title: Sternal closure after median sternotomy: a new technique using titanium hooks and wires applied parasternally.
abstract: OBJECTIVE
  Osteosynthetic closure of the chest after median sternotomy is usually performed with steel wires. We describe, for the first time, a case series in which titanium hooks were implanted from the sternal surface in patients who required secondary or additional stabilization. In comparison to the classic wires, the diameters of the hooks are approximately three times bigger and therefore reduce the risk of cutting through the bones. Additionally, there is no need to dissect retrosternal adhesions, which may reduce the risk of injuring mediastinal tissues.
  
  
  METHODS
  The hooks are shaped like fishing hooks and can be inserted parasternally into the intercostal spaces. They can be pulled to the contralateral side of the sternum by the attached wires and then intertwined with a second hook.
  
  
  RESULTS
  In 13 patients, the system was used to provide additional stabilization, while in two patients the hooks were implanted for exclusive stabilization of sternal fractures. In all cases but one, the implantation was able to eliminate the sternal problems. No infections, necrosis or bleeding of neighbouring tissues occurred. One patient developed chronic sternal infection, which necessitated explantation of the hooks.
  
  
  CONCLUSIONS
  This sternal closure system using titanium hooks inserted parasternally is an effective alternative to conventional techniques and may increase stability of the breastbone and reduce the risk of injury to retrosternal tissues.
authors: Department of Cardiac Surgery, Chirurgische Klinik Dr. Rinecker, Munich, Germany. kilian@rinecker.de
authors: Eckehard
authors: E
authors: Kilian
authors: Helmut
authors: H
authors: Mair
authors: Bruno
authors: B
authors: Reichart
authors: Peter
authors: P
authors: Lamm
mesh_terms: D001864:Bone Wires; D006801:Humans; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation*; D011183:Postoperative Complications / Q000517:prevention & control; D011474:Prosthesis Design; D056346:Sternotomy; D014025:Titanium; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000009:adverse effects / Q000295:instrumentation*
chemical_list: D014025:Titanium
keywords: Additional stabilization; Sternal closure; Titanium hooks