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Critical Reviews™ in Biomedical Engineering
SJR: 0.207 SNIP: 0.376 CiteScore™: 0.79

ISSN Druckformat: 0278-940X
ISSN Online: 1943-619X

Volumes:
Volumen 47, 2019 Volumen 46, 2018 Volumen 45, 2017 Volumen 44, 2016 Volumen 43, 2015 Volumen 42, 2014 Volumen 41, 2013 Volumen 40, 2012 Volumen 39, 2011 Volumen 38, 2010 Volumen 37, 2009 Volumen 36, 2008 Volumen 35, 2007 Volumen 34, 2006 Volumen 33, 2005 Volumen 32, 2004 Volumen 31, 2003 Volumen 30, 2002 Volumen 29, 2001 Volumen 28, 2000 Volumen 27, 1999 Volumen 26, 1998 Volumen 25, 1997 Volumen 24, 1996 Volumen 23, 1995

Critical Reviews™ in Biomedical Engineering

DOI: 10.1615/CritRevBiomedEng.2019026453
pages 27-57

Rationale and Options for Choosing an Optimal Closure Technique for Primary Midsagittal Osteochondrotomy of the Sternum, Part 2: A Theoretical and Critical Review of Techniques and Fixation Devices

Harjeet Singh Gandhi
Hamilton Health Sciences, Suite 515, 644 Main Street West, Hamilton, Ontario, Canada L8S 1A1

ABSTRAKT

The intact one-piece sternum is indispensible to the thorax for its normal physiological biomechanics. To overcome tri-planar forces acting on the sternum following midsagittal osteochondrotomy, it must be reconstructed using an optimal technique to withstand distraction loads of normal respiration and violent cough. It should be fixed rigidly to reconstitute the anterior coronal column of the axial skeleton to maintain erect posture and prevent kyphosis. Sterile or infective non-union of the sternum compromises the physical endurance of patients and has an immense psychological effect. From an engineering perspective, there is no substantially proven gold standard technique to fix a divided sternum. Stainless steel wire applied in various configurations to a variety of shapes and sizes has become an acceptable standard of care due to its long-standing history and cost-effectiveness. Recently there has been a proliferation of innovative techniques to deal with primary and failed union of the sternum in an effort to prevent mechanical failure and serious deep surgical wound infection progressing to mediastinitis. Among the newer implant designs, the ones currently in use are shaped like clamps and clasps to compress the sternal halves together as well as alphabet-shaped mini-plating systems. In this section of the review series, mechanisms, pros and cons of currently available implants to reconstruct the bisected sternum, and external support systems considered necessary in high-risk clients are discussed.