Fixing a Traumatic Sternal Fracture Using Stainless Steel Wires

Hussein Elkhayat; Hager Nousseir

doi:10.5812/traumamon.27231

Fixing a Traumatic Sternal Fracture Using Stainless Steel Wires

Hussein Elkhayat ^{1
, *} and Hager Nousseir ²

Authors Information

¹ Department of Cardiothoracic Surgery, Faculty of Medicine, Assiut University Heart Hospital, Assiut University, Assiut, Egypt

² Department of Chest Diseases, Assiut Police Hospital, Assiut, Egypt

Article information

Trauma Monthly: May 01, 2016, 21 (2); e27231
Published Online: May 10, 2016
Article Type: Letter
Received: February 26, 2015
Accepted: June 28, 2015
DOI: 10.5812/traumamon.27231

To Cite: Elkhayat H, Nousseir H. Fixing a Traumatic Sternal Fracture Using Stainless Steel Wires, Trauma Mon. 2016 ; 21(2):e27231. doi: 10.5812/traumamon.27231.

Copyright © 2016, Trauma Monthly. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

Possible Indications and Timing for Sternal Fracture Fixation

Immediate or During the Initial Admission

Delayed

General Considerations

- Echocardiography is an important preoperative workup to exclude pericardial collection.

- General anesthesia with epidural catheter,

- Supine position with a sandbag below the patient’s shoulders.

- Examination under general anesthesia of the fracture site and the adjacent costochondral joints,

- Midline incision over the site of the fracture (usually 10 cm long),

- Raising a pectoralis muscle flap on both sides of the fracture to buttress the sternum,

- Identification of the fracture site,

- Use a malleable metal tongue retractor to raise the inner plate of the sternum and protect the heart and great vessels during insertion of the stainless steel wire’s needle.

- Using an illustration of eight stitch or simple one stich according to the degree of displacement and available space to approximate (Figure 2).

Figure 2. Intraoperative Photo of the Fracture Site With Two Simple Wires in Place

- In cases of comminuted fractures or where sliding fracture edges are reaching the inner plate of the sternum, where it will be difficult or lead to losing parts of the outer plate, one can use a No.2 delayed absorbable suture passing from the outer plate and coming up at the marrow of the sternum without reaching the inner plate. This is likely to be less effective than a full thickness wire suture but with a buttressing of the muscle flap, one can achieve satisfactory results.

- Adjacent costochondral fractures are best sutured using delayed absorbable sutures with approximation of the two ends gently to prevent perichondreal injury.

- Put a suction drain of appropriate size just above the sternum unless you put a chest tube for the already-opened pleura during the operation.

- We routinely use a topical antibiotic above the sternum to guard against mediastinitis.

- Closure of muscle flaps in the midline to reinforce the fracture site,

- Closure of the subcutaneous tissue and skin,

- Extubation on a tabulation is the target unless there is associated lung contusion or other injuries requiring mechanical ventilation.

- Drain usually removed after 48 hours,

- Patient is discharged home after control of pain and removal of epidural catheter and drain.

References

1. Athanassiadi K, Gerazounis M, Moustardas M, Metaxas E. Sternal fractures: retrospective analysis of 100 cases. World J Surg. 2002; 26(10): 1243-6[DOI][PubMed]
2. Ergene G, Tulay CM, Anasiz H. Sternal fixation with nonspecific plate. Ann Thorac Cardiovasc Surg. 2013; 19(5): 364-7[PubMed]
3. Harston A, Roberts C. Fixation of sternal fractures: a systematic review. J Trauma. 2011; 71(6): 1875-9[DOI][PubMed]

Trauma Monthly

Published by: Kowsar

Fixing a Traumatic Sternal Fracture Using Stainless Steel Wires

Article information

Possible Indications and Timing for Sternal Fracture Fixation

Immediate or During the Initial Admission

Delayed

General Considerations

References

Readers' Comments

Trauma Monthly

Published by: Kowsar

Fixing a Traumatic Sternal Fracture Using Stainless Steel Wires

Article information

Possible Indications and Timing for Sternal Fracture Fixation

Immediate or During the Initial Admission

Delayed

General Considerations

References

Share on:

Readers' Comments:

Readers' Comments