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A randomized trial comparing the effects of sternal band and plate fixation of the sternum with that of figure-of-8 wires on sternal edge motion and quality of recovery after cardiac surgery
- Source :
- Interactive cardiovascular and thoracic surgery. 30(6)
- Publication Year :
- 2019
-
Abstract
- OBJECTIVES We sought to compare the effects of conventional wire cerclage with that of the band and plate fixation of the sternum. METHODS A parallel randomized open-label trial with 1:1 allocation ratio compared healing after adult cardiac surgery using ‘figure-of-8’ stainless steel wire cerclage or a band and plate system (plates). The primary end point was maximal sternal edge displacement during active coughing of ≥2 mm in ≥2 of 4 sites measured with ultrasound by 2 assessors blinded to the other at 6 weeks postoperatively. Secondary end points at 12 weeks included ultrasound assessment, computed tomography (CT) scan and multidimensional assessment of quality of recovery using the Postoperative Quality of Recovery Scale. RESULTS Of 50 patients, 26 received plates and 24 wires. Two patients died and 1 withdrew consent leaving 25 plates and 22 wires for primary end point analysis. Operations included 37 coronary, 5 valve and 8 combined coronary and valve procedures. At 6 weeks, less sternal movement was observed in patients with plates than those with wires, 4% (1/25) vs 32% (7/22), P = 0.018. Agreement between observers was high, kappa = 0.850. At 12 weeks, less ultrasound motion was seen in patients with plates, 0% (0/23) than those with wires, 25% (5/20), P = 0.014. Recovery from pain was higher for patients with plates 92% (22/24) than those with wires 67% (14/21), P = 0.004. CT bone edge separation was less for plates 38% (9/24) than wires 71% (15/21), P = 0.036. CT mild bone synthesis or greater was similar between patients with plates 21% (5/24) and wires 14% (3/21), P = 0.71. CONCLUSIONS Patients receiving the band and plate system had significantly less sternal edge motion than those receiving wires, 6 and 12 weeks after cardiac surgery and experienced less pain. Clinical trial registration clinicaltrials.gov NCT03282578.
- Subjects :
- Pulmonary and Respiratory Medicine
Male
medicine.medical_specialty
Sternum
medicine.medical_treatment
Computed tomography
law.invention
Randomized controlled trial
law
Bone plate
Medicine
Humans
Postoperative Period
Cardiac Surgical Procedures
Plate fixation
Ultrasonography
Wound Healing
medicine.diagnostic_test
business.industry
Wound Closure Techniques
Ultrasound
Recovery of Function
Middle Aged
Sternotomy
Cardiac surgery
Median sternotomy
Quality of Life
Surgery
Female
Cardiology and Cardiovascular Medicine
business
Nuclear medicine
Tomography, X-Ray Computed
Bone Plates
Bone Wires
Subjects
Details
- ISSN :
- 15699285
- Volume :
- 30
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Interactive cardiovascular and thoracic surgery
- Accession number :
- edsair.doi.dedup.....d087960011a02e044704e9934d89ae92