Asian Cardiovasc Thorac Ann 2007;15:182
© 2007 Asia Publishing EXchange Ltd
SIMPLE WIRING FOR STERNAL FRACTURE
R Karthik Vaidyanathan, MS,
Sanjay Theodore, MCh,
Madhu N Sankar, PhD,
KM Cherian, FRACS
Department of Cardiac Surgery, International Centre for CardioThoracic and Vascular Diseases, R 30 C Ambattur Industrial Estate Road, Mogappair Chennai 600 101 India
The article entitled ‘Operative Treatment of Sternal Fractures’ was quite interesting1. The authors need to be congratulated for their excellent work. We recently had a patient with sternal fracture (Fig 1A
) who presented to us one week after a high speed head on collision, with severe debilitating pain. He underwent figure of eight fixation with No 6 stainless steel wires with a good post operative result (Fig 1B).
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Figure 1 (A) CT scan showing transverse fracture of sternum with displacement; (B) Well aligned fracture after figure of eight fixation in traumatic fractures when they are not multiple or comminuted.
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The scientific reason put forth by the authors for using plates and screws sound plausible. However, our technique is simpler and at the same time at least as effective. After all, approximation with steel wires is being done routinely for surgical sternotomies (midline and clam-shell) all over the world and there is no reason to believe that this method would not work
The concern that the authors raise about the interference of blood supply during mediastinal dissection is unfounded. Human cadaver studies have shown beyond doubt that the sternum receives its blood supply from the perforating and sternal branches of the internal mammary artery that arise para sternally and not from the underlying mediastinum2. In the rare event that the native blood supply is compromised by trauma, it is unlikely that extensive collaterals would form so soon before the patient undergoes surgical fixation. In the hands of a competent cardiothoracic surgeon, mediastinal dissection to define the edges of the fracture is safe and the use of steel wires to fix the fracture is in no way hazardous.
REFERENCES
- Al-Qudah A. Operative Treatment of Sternal Fractures. Asian Cardiovasc Thorac Ann 2006;14:399–401.[Abstract/Free Full Text]
- Berdajs D, Zünd G, Turina MI, Genoni M. Blood Supply of the Sternum and its Importance in Internal Thoracic Artery Harvesting. Ann Thorac Surg 2006;81:2155–9.[Abstract/Free Full Text]
