This study evaluated patients with previous coronary artery bypass grafting and found that 27.2 percent had fractured sternal wires, with significant risk factors including higher body mass index, male sex, and longer time since surgery. Fractures were most common in figure-of-eight wire configurations and at the points where wires bend around the sternum, highlighting the need for further research into the clinical implications of these fractures.
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Fractured Sternal Wires Post-Coronary Surgery: A Cross-Sectional Study Examining Wire Configurations, Sternal Locations, and Breakage Sites
Submitted by: Joel Dunning
Source: The Annals of Thoracic Surgery
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Author(s): Klaudiusz Stoklosa, Delia Munteanu, Kevin Lachapelle, Marco Spaziano, Dominique Shum-Tim, Benoit de Varennes, Christo Tchervenkov, David Drullinsky
1 Comment
We found in a patient the sternal wires fractured in more points. One can understand that the forces applied against the wire can logorate or disrupt the continuity in one point, but it is very strange that it could happen in more sites of the wire. In particular that patient has rewired three time and always the wires has been found disrupted in more places.
The stainless steel used for sternal wires is an alloy of metals, the most common being chromium, nickel, and molybdenum, besides iron. However, there is a possibility that certain sets may contain contaminants, particularly aluminum. As is well known, aluminum reacts in both environments, whether acidic or basic.
This was our interpretation as the second fracture of the sternal wire was no longer attributable to tensile forces, but rather than to something that was inherent in the material itself.
Moreover we changed the provider of the sternal wires and the phenomenon never happened again.
In our Institution the solution to prevent sternal fractures was to use two passes of the suture instead of a single pass through the same intercostal space. The applied force was doubled (the law of the double hoist), and so was the bone surface area over which the force was applied. Using this method, sternal dehiscences, especially in cases involving a double mammary artery, virtually disappeared.