Devices made of metal plates and screws that can precisely align and stabilize fractured bones as they heal can safely and effectively repair the sternum, according to a review of UC Davis surgeries published in the May issue of the Annals of Plastic Surgery.
Over the past five decades, the standard approach to repairing sternum fractures has been wire “stitches,” according to Michael Wong, professor of surgery at UC Davis and senior author of the journal paper.
“Chest surgeons have been reluctant to make the transition from wire closure to rigid sternal fixation, even though it has become the standard-of-care for other bone reconstructions,” said Wong, a specialist in plastic and reconstructive surgery. “Our study adds to growing evidence that it can be beneficial for the breastbone, too.”
To get a cumulative view of their experiences with rigid sternal fixation, Wong and his colleagues evaluated risk factors and outcomes for 57 patients at UC Davis Medical Center between 2006 and 2012. The patients included males and females between the ages of 16 and 70 who needed breastbone reconstruction or stabilization for a variety of reasons.
Thirty-five patients had sternotomies, or surgical divisions of the breastbone, during open chest surgery. All of them were at high risk for developing mediastinitis — a potentially fatal inflammation of the space around the heart — because of obesity, diabetes, COPD or other medical factors. An additional 14 had prior sternal reconstructions that failed, four had sternums damaged due to trauma and four had congenital abnormalities of the sternum.
The outcomes showed that none of the patients developed mediastinitis, which may occur in up to 15 percent of high-risk patients following chest surgery that uses the breastbone for access to the heart. Fourteen patients had mostly minor post-operative complications. Only three of them (fewer than 1 percent) had complications that warranted reoperations to remove or adjust the sternal plating hardware.
“All surgical techniques can have complications, but a growing portion of our work is treating complications of wire closures with sternal plates and screws,” said Wong. “It’s time to start considering rigid techniques first when it comes to repairing the sternum, at the very least among patients at higher risk for complications.”
This study is one of a series from Wong on rigid fixation. In 2012, he showed that the sternal devices resulted in shorter healing times and reduced pain when compared to wire closures, and he will soon publish a cost comparison of both approaches. He is also working with UC Davis cardiothoracic surgeon Broadus Zane Atkins on studies to determine which type of rigid device works best for patients with osteoporosis, a notoriously challenging condition for surgeons given that it can make patients’ bones more brittle and difficult to repair.
The current study — titled “Rigid Fixation for the Prevention and Treatment of Sternal Complications: A Review of Our Experience” — had no external funding. Wong’s co-authors were UC Davis plastic surgery residents Rahim Nazerali and Katharine Hinchcliff.
UC Davis Medical Center is a comprehensive academic medical center where clinical practice, teaching and research converge to advance human health. The medical center serves a 33-county, 65,000-square-mile area that stretches north to the Oregon border and east to Nevada. It further extends its reach through the award-winning telemedicine program, which gives remote, medically underserved communities throughout California unprecedented access to specialty and subspecialty care. For more information, visit medicalcenter.ucdavis.edu.