Sternal Fixation With Synthes® Titanium Sternal Fixation System Using
Preoperative 3-Dimensional Planning and a Patient-Specific Surgical
Guide.
Abstract
Sternal refixation or reconstruction of a median sternotomy can be
indicated after treatment of deep sternal wound infection or bony
non-union. Synthes® Titanium Sternal Fixation System is routinely used
for sternal refixation. To perform a stable reconstruction, the titanium
plates need to be bent to the anatomical shape of the sternum and
adjacent ribs. The procedure offers good results, but can be, especially
in the case of a complex non-union or a complex anatomy, time-consuming.
Based on pre-operative CT-scan a 3D model of the sternum was printed
(Materialise, Belgium). The operation was simulated using 3D software
(Materialise, Belgium) and the two parts were aligned. The titanium
plates were bent to fit the anatomical shape of the 3D model
pre-operatively. During surgery the plates were fitted and if necessary
additional bending was performed. Case 1: Total pre-operative bending
time for the relative simple anatomic shape and mal-union was 53
minutes. Total operative time was 1 hour 19 minutes. Case 2: Total
pre-operative bending time for a complicated non-union and anatomy was 1
hour 21 minutes. Total operative time was 1 hour 43 minutes. Because of
pre-operative bending, total operative time could be reduced by
approximately 40-45%. Additional bending was rarely necessary. This
case series demonstrates that the use of 3-dimensional planned
patient-specific guides and preoperative preparations can help reduce
operating time with satisfactory preliminary results.