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Eur J Cardiothorac Surg 2001;19:249-253
© 2001 Elsevier Science NL

Fatigue testing median sternotomy closures

^a Department of Cardio-thoracic Surgery, Leeds General Infirmary, Leeds LS1 3EX, UK
^b Department of Anaesthesia and Intensive Care, University of Wales College of Medicine, Cardiff CF14 4XN, UK
^c Department of Biomechanics, Clinical Sciences Building, Northern General Hospital, Sheffield S5 7AU, UK
^d Department of Cardio-thoracic Surgery, Northern General Hospital, Sheffield S5 7AU, UK

Received 9 October 2000; received in revised form 15 December 2000; accepted 30 December 2000.

Corresponding author. Tel.: +44-113-2456170; fax: +44-113-2456170.

Objective: Sternal dehiscence is commonly due to wire cutting through bone. With a biological model, we measured the rate of cutting through bone, of standard steel wire closure, peristernal steel wire, figure-of-eight closure, polyester and sternal bands sternotomy closure techniques. Methods: Polyester, figure-of-eight, peristernal and sternal band closures were tested against standard closure eight times using adjacent paired samples, to eliminate biological variables. Fatigue testing was performed by a computerized materials-testing machine, cycling between loads of 1 and 10 kg. The displacements at maximum and minimum loads were measured during each cycle. Cutting through, manifested by the displacement at the maximum load between the 1st and 150th cycles was measured. The percentage cut-through of each closure method versus standard closure was calculated. Results: The differences in the displacement between each of the polyester (1.01 mm), figure-of-eight (0.52 mm), peristernal (0.72 mm) and sternal band (0.66 mm) groups versus standard closure (0.22, 0.22, 2.1, 3.2 mm) in the paired samples were statistically significant (Student's paired t-test; P<0.01). There were statistically significant differences in the percentage cut-through of polyester, figure-of-eight, peristernal and sternal bands (ANOVA, P<0.001), versus standard closure. Conclusions: In our sheep sternum model, we have quantified the differing rate of cutting through bone of five types of median sternotomy closure techniques. We have controlled for bone variables by testing each closure versus standard closure using paired adjacent bone samples. Peristernal and sternal band closure techniques are significantly superior to standard closure. The use of polyester and figure-of-eight closures requires caution.

Key Words: Sternotomy • Biomechanics • Fatigue

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