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A Mechanical Study of Rigid Plate Configurations for Sternal Fixation

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Abstract

Rigid metal plates are a promising alternative to wires for reapproximating the sternum after open-heart surgery due to their potential ability to reduce motion at the wound site and thereby reduce the likelihood of post-operative healing complications. Despite initial clinical success, the use of plates has been limited, in part, by insufficient knowledge about their most effective placement. This study compares the ability of five plate configurations to provide stable closure by limiting sternal separation. Commercially available x-shaped and box-shaped plates were used and combinations of parameters (plate type, location, and number of plates) were investigated in vitro. Lateral distraction tests using controlled, uniform loading were conducted on 15 synthetic sterna and the distractions between separated sternum halves were measured at seven locations. Distractions at the xiphoid, a critical region clinically, varied widely from 0.03 ± 0.53 mm to 4.24 ± 1.26 mm depending on all three plate parameters. Of the configurations tested, three x-shaped plates and one box-shaped plate resisted sternal separation most effectively. These results provide the first comparison of plate configurations for stabilizing a sternotomy. However, basic mechanical analyses indicate that sternal loading in vivo is non-uniform; future studies will need to accurately quantify in vivo loading to improve in vitro test methods.

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Abbreviations

M:

manubrium (graphite marker measurement location)

MS1:

midsternum one (graphite marker measurement location)

MS2:

midsternum two (graphite marker measurement location)

MS3:

midsternum three (graphite marker measurement location)

MS4:

midsternum four (graphite marker measurement location)

MS5:

midsternum five (graphite marker measurement location)

X:

xiphoid (graphite marker measurement location)

7S:

seven simple straight wires, used in this study as the standard wire configuration

3X:

three “X”-shaped plates spaced evenly down the sternum

3XO:

similar to 3X only the third plate was placed towards the xiphoid

4X:

four “X”-shaped plates spaced evenly down the sternum

2X-1Box:

similar to 3XO only the third “X”-shaped plate was replaced with a Box-plate

3X-1Box:

similar to 4X only the fourth “X”-shaped plate was replaced with a Box-plate

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Acknowledgments

The authors would like to thank Shon Steger of W. Lorenz Surgical, Timothy Roth of the University of Massachusetts Medical Center, and Oljeta Bida and Helena Zec of Worcester Polytechnic Institute for their advice and assistance. We would also like to thank Jim Greene of JMR Systems Inc. for digitizing the surface of the sternal model.

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Authors and Affiliations

  1. Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA

    Shruti Pai, Erin L. Dupak, Nicole L. McMahon, George D. Pins & Kristen L. Billiar

  2. Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA

    Najmuddin J. Gunja & Kristen L. Billiar

  3. Department of Surgery, Division of Plastic Surgery, University of Massachusetts Medical Center, Worcester, MA, USA

    Janice F. Lalikos, Raymond M. Dunn & Kristen L. Billiar

  4. Department of Mechanical Engineering, National University of Ireland, Galway, Ireland

    James C. Coburn

  5. Department of Surgery, Division of Cardiac Surgery, University of Massachusetts Medical Center, Worcester, MA, USA

    Nicola Francalancia

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  1. Shruti Pai
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  2. Najmuddin J. Gunja
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  3. Erin L. Dupak
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  4. Nicole L. McMahon
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  6. Janice F. Lalikos
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  7. Raymond M. Dunn
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  8. Nicola Francalancia
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  9. George D. Pins
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  10. Kristen L. Billiar
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Corresponding author

Correspondence to Kristen L. Billiar.

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Pai, S., Gunja, N.J., Dupak, E.L. et al. A Mechanical Study of Rigid Plate Configurations for Sternal Fixation. Ann Biomed Eng 35, 808–816 (2007). https://doi.org/10.1007/s10439-007-9272-3

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  • DOI: https://doi.org/10.1007/s10439-007-9272-3

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