Comparison of straight median sternotomy and interlocking sternotomy with respect to biomechanical stability

Abstract

AIM: To increase the stability of sternotomy and so decrease the complications because of instability.

METHODS: Tests were performed on 20 fresh sheep sterna which were isolated from the sterno-costal joints of the ribs. Median straight and interlocking sternotomies were performed on 10 sterna each, set as groups 1 and 2, respectively. Both sternotomies were performed with an oscillating saw and closed at three points with a No. 5 straight stainless-steel wiring. Fatigue testing was performed in craniocaudal, anterio-posterior (AP) and lateral directions by a computerized materials-testing machine cycling between loads of 0 to 400 N per 5 s ( 0.2 Hz). The amount of displacement in AP, lateral and craniocaudal directions were measured and also the opposing bone surface at the osteotomy areas were calculated at the two halves of sternum.

RESULTS: The mean displacement in cranio-caudal direction was 9.66 +/- 3.34 mm for median sternotomy and was 1.26 +/- 0.97 mm for interlocking sternotomy, P < 0.001. The mean displacement in AP direction was 9.12 +/- 2.74 mm for median sternotomy and was 1.20 +/- 0.55 mm for interlocking sternotomy, P < 0.001. The mean displacement in lateral direction was 8.95 +/- 3.86 mm for median sternotomy and was 7.24 +/- 2.43 mm for interlocking sternotomy, P > 0.001. The mean surface area was 10.40 +/- 0.49 cm(2) for median sternotomy and was 16.8 +/- 0.78 cm(2) for interlocking sternotomy, P < 0.001. The displacement in AP and cranio-caudal directions is less in group 2 and it is statistically significant. Displacement in lateral direction in group 2 is less but it is statistically not significant. Surface area in group 2 is significantly wider than group 1.

CONCLUSION: Our test results demonstrated improved primary stability and wider opposing bone surfaces in interlocking sternotomy compared to median sternotomy. This method may provide better healing and less complication rates in clinical setting, further studies are necessary for its clinical implications. (C) 2013 Baishideng. All rights reserved.