Surgical Case Reports | 2021
Sternal Fixation with Synthes® Titanium Sternal Fixation System Using Preoperative 3-Dimensional Planning and a Patient-Specific Surgical Guide: A Pilot Study
Abstract
Sternal refixation or reconstruction of a median sternotomy can be indicated after treatment of deep sternal \nwound infection or bony non-union. Synthes® Titanium Sternal Fixation System is routinely used for \nsternal refixation. To perform a stable reconstruction, the titanium plates need to be bent to the anatomical \nshape of the sternum and adjacent ribs. The procedure offers good results, but can be, especially in the case \nof a complex non-union or a complex anatomy, time-consuming. Based on pre-operative CT-scan a 3D \nmodel of the sternum was printed (Materialise, Belgium). The operation was simulated using 3D software \n(Materialise, Belgium) and the two parts were aligned. The titanium plates were bent to fit the anatomical \nshape of the 3D model pre-operatively. During surgery the plates were fitted and if necessary additional \nbending was performed. Case 1: Total pre-operative bending time for the relatively simple anatomic shape \nand mal-union was 53 minutes. Total operative time was 1 hour 19 minutes. Case 2: Total pre-operative \nbending time for a complicated non-union and anatomy was 1 hour 21 minutes. Total operative time was 1 \nhour 43 minutes. Because of pre-operative bending, total operative time could be reduced by approximately \n40-45%. Additional bending was rarely necessary. This case series demonstrates that the use of 3-\ndimensional planned patient-specific guides and preoperative preparations can help reduce operating time \nwith satisfactory preliminary results.