Surgical fixation of sternal fractures: preoperative planning and a safe surgical technique using locked titanium plates and depth limited drilling.

Surgical fixation of sternal fractures: preoperative planning and a safe surgical technique using locked titanium plates and depth limited drilling.

Journal of visualized experiments : JoVE (2015-01-16)

Stefan Schulz-Drost, Pascal Oppel, Sina Grupp, Sonja Schmitt, Roman Th Carbon, Andreas Mauerer, Friedrich F Hennig, Thomas Buder

PMID25590989

ABSTRACT

Different ways to stabilize a sternal fracture are described in literature. Respecting different mechanisms of trauma such as the direct impact to the anterior chest wall or the flexion-compression injury of the trunk, there is a need to retain each sternal fragment in the correct position while neutralizing shearing forces to the sternum. Anterior sternal plating provides the best stability and is therefore increasingly used in most cases. However, many surgeons are reluctant to perform sternal osteosynthesis due to possible complications such as difficulties in preoperative planning, severe injuries to mediastinal organs, or failure of the performed method. This manuscript describes one possible safe way to stabilize different types of sternal fractures in a step by step guidance for anterior sternal plating using low profile locking titanium plates. Before surgical treatment, a detailed survey of the patient and a three dimensional reconstructed computed tomography is taken out to get detailed information of the fracture's morphology. The surgical approach is usually a midline incision. Its position can be described by measuring the distance from upper sternal edge to the fracture and its length can be approximated by the summation of 60 mm for the basis incision, the thickness of presternal soft tissue and the greatest distance between the fragments in case of multiple fractures. Performing subperiosteal dissection along the sternum while reducing the fracture, using depth limited drilling, and fixing the plates prevents injuries to mediastinal organs and vessels. Transverse fractures and oblique fractures at the corpus sterni are plated longitudinally, whereas oblique fractures of manubrium, sternocostal separation and any longitudinally fracture needs to be stabilized by a transverse plate from rib to sternum to rib. Usually the high convenience of a patient is seen during follow up as well as a precise reconstruction of the sternal morphology.

MATERIALS

Product Number

Brand

Product Description

IRMM531B

Titanium, IRMM^®, certified reference material, 0.5 mm foil

348791

Sigma-Aldrich

Titanium, foil, thickness 0.127 mm, 99.7% trace metals basis

266035

Sigma-Aldrich

Titanium, wire, diam. 1.0 mm, 99.99% trace metals basis

IRMM531C

Titanium, IRMM^®, certified reference material, 0.5 mm wire

369489

Sigma-Aldrich

Titanium, foil, thickness 2.0 mm, 99.7% trace metals basis

267902

Sigma-Aldrich

Titanium, wire, diam. 0.81 mm, 99.7% trace metals basis

460400

Sigma-Aldrich

Titanium, wire, diam. 0.25 mm, 99.7% trace metals basis

305812

Sigma-Aldrich

Titanium, 5-10 mm, ≥99.99% trace metals basis (purity exclusive of Na and K content)

348848

Sigma-Aldrich

Titanium, foil, thickness 0.025 mm, 99.98% trace metals basis

GF65336700

Titanium, rod, 200mm, diameter 2mm, annealed, 99.6+%

GF76772391

Titanium, rod, 100mm, diameter 10mm, annealed, 99.6+%

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Titanium, rod, 100mm, diameter 16mm, as drawn, 99.99+%

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Titanium, microfoil, disks, 10mm, thinness 1.0μm, specific density 429μg/cm², permanent mylar 3.5μm support, 99.6+%

GF03916290

Titanium, rod, 490mm, diameter 2mm, annealed, 99.6+%

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Titanium, tube, 1220mm, outside diameter 2.03mm, inside diameter 1.55mm, wall thickness 0.24mm, annealed, 99.6+%

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Titanium, tube, 1000mm, outside diameter 6.35mm, inside diameter 4.57mm, wall thickness 0.89mm, annealed, 99.6+%

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Titanium, rod, 25mm, diameter 16mm, as drawn, 99.99+%

GF03838282

Titanium, rod, 500mm, diameter 1.5mm, annealed, 99.6+%

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Titanium, rod, 100mm, diameter 6mm, annealed, 99.6+%

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Titanium, tube, 1000mm, outside diameter 25.4mm, inside diameter 23.62mm, wall thickness 0.89mm, annealed, 99.6+%

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Titanium, rod, 200mm, diameter 5mm, annealed, 99.6+%

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Titanium, tube, 100mm, outside diameter 1.6mm, inside diameter 1.2mm, wall thickness 0.2mm, hard, 99.6+%

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Titanium, rod, 200mm, diameter 4mm, annealed, 99.6+%

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Titanium, rod, 1000mm, diameter 1.5mm, annealed, 99.6+%

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Titanium, microfoil, disks, 25mm, thinness 0.25μm, specific density 112.6μg/cm², permanent mylar 3.5μm support, 99.6+%

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Titanium, tube, 100mm, outside diameter 2.03mm, inside diameter 1.63mm, wall thickness 0.2mm, annealed, 99.6+%

GF69259315

Titanium, rod, 500mm, diameter 6mm, annealed, 99.6+%

GF62676759

Titanium, rod, 200mm, diameter 2mm, as drawn, 99.99+%

GF85496664

Titanium, tube, 1000mm, outside diameter 9.5mm, inside diameter 8.2mm, wall thickness 0.65mm, annealed, 99.6+%

GF28411703

Titanium, tube, 100mm, outside diameter 10.3mm, inside diameter 8.7mm, wall thickness 0.8mm, annealed, 99.6+%