Rigid plate fixation for sternal closure

Abstract

Median sternotomy provides standard access in cardiac surgery. Sternal closure traditionally involves use of stainless steel wires with satisfactory results. Fixation of sternum using titanium plates with screws has been used in some institutions over the last two decades. This technique uses sternal wires in combination with a rigid plate fixation system. The wires are passed at the manubrium and xiphoid to help with approximation, while plates are used to fix the body of the sternum. The screws are passed through the outer table and penetrate the inner table of the sternum. There is increasing evidence to suggest that rigid plate fixation provides better mechanical stability of sternum; which seems to translate to less post-operative pain; better healing of sternum; lower incidence of deep sternal wound infection and sternal non-union. This approach is particularly useful in patients who have multiple risk factors predisposing them to post-operative sternal complications.