Sternal malunion fixation using a Titanium Sternal Fixation System in a diabetic patient. The first of its kind in Scotland

Abstract

Sternal non-union is a rare but serious complication post-sternotomy. It is defined as sternal pain with clicking, instability, or both for more than 6 months in the absence of infection and usually presents in an outpatient setting. It may result in multiple admissions to the hospital for surgical debridement and wound care therapies. Several risk factors have been identified in the literature but treatment options are limited. Proven benefits of increased stability and decreased incidence of non-union using the principles of rigid fixation have been described in other surgical specialties such as orthopaedic surgery. Employing this, the authors describe the first successful sternal non-union fixation using the Titanium Sternal Fixation System (DepuySynthes) in Scotland.

Keywords

Sternal fixation / sternal dehiscence / diabetes / bilateral internal thoracic artery

References

[1] Tavilla G,Verhagen AF.Modified Robicsek technique for complicated sternal closure..Ann Thorac Surg1991;52:1179-80

[2] Serruys PW,Kappetein AP,Holmes DR,Ståhle E,van den Brand M,Van Dyck N,Dawkins KD.Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease..N Engl J Med2009;360:961-72

[3] Taggart DP.Bilateral internal mammary artery grafting: are BIMA better?.Heart2002;88:7-9 PMCID:PMC1767172

[4] Taggart DP,Wong P,Wright JE.Applicability of intermittent global ischemia for repeat coronary artery operations..J Thorac Cardiovasc Surg1996;112:501-7

[5] Yi G,Rehman SM,Taggart DP.Effect of bilateral internal mammary artery grafts on long-term survival: a meta-analysis approach..Circulation2014;130:539-45

[6] Nasso G,Bonifazi R,Bozzetti G.Arterial revascularization in primary coronary artery bypass grafting: direct comparison of 4 strategies--results of the Stand-in-Y Mammary Study..J Thorac Cardiovasc Surg2009;137:1093-100

[7] Grossi EA,Harris LJ,Galloway AC,Culliford AT,Yao K.Sternal wound infections and use of internal mammary artery grafts..J Thorac Cardiovasc Surg1991;102:342-6; discussion 346-7

[8] De Paulis R,Scaffa R,Zeitani J,De Peppo AP,Chiariello L.The effect of bilateral internal thoracic artery harvesting on superficial and deep sternal infection: The role of skeletonization..J Thorac Cardiovasc Surg2005;129:536-43

[9] Ogawa S,Sawada K,Yamamoto M,Baba H.Continuous postoperative insulin infusion reduces deep sternal wound infection in patients with diabetes undergoing coronary artery bypass grafting using bilateral internal mammary artery grafts: a propensity-matched analysis..Eur J Cardiothorac Surg2016;49:420-6

[10] Hirotani T,Kumamoto T,Yamano M.Effects of coronary artery bypass grafting using internal mammary arteries for diabetic patients..J Am Coll Cardiol1999;34:532-8

[11] Jeong DS,Lee YT,Carriere KC,Park PW.Pure bilateral internal thoracic artery grafting in diabetic patients with triple-vessel disease..Ann Thorac Surg2015;100:2190-7

[12] Schimmer C,Elert O.Primary closure of median sternotomy: a survey of all German surgical heart centers and a review of the literature concerning sternal closure technique..Thorac Cardiovasc Surg2006;54:408-13

[13] Hillis LD,Anderson JL,Bridges CR,Cigarroa JE,Hiratzka LF,Jessen ME,Lahey SJ,London MJ,Patel MR,Sabik JF,Shahian DM,Winniford MD.2011 ACCF/AHA guideline for coronary artery bypass graft surgery: a report of the american college of cardiology foundation/american heart association task force on practice guidelines..Circulation2011;124:e652-735

[14] Hendrickson SC,Morea CJ,Smith PK.Sternal plating for the treatment of sternal nonunion..Ann Thorac Surg1996;62:512-8

[15] Bennett-Guerrero E,Waweru PM,Spann JC.Pilot study of sternal plating for primary closure of the sternum in cardiac surgical patients..Innovations (Phila)2011;6:382-8

[16] Vos RJ,Sonker U.Titanium plate fixation versus conventional closure for sternal dehiscence after cardiac surgery..Thorac Cardiovasc Surg2017;65:338-42

[17] Kim WK,Kim GS,Choo SJ,Lee JW.Titanium plate fixation for sternal dehiscence in major cardiac surgery..Korean J Thorac Cardiovasc Surg2013;46:279-84 PMCID:PMC3756159