Sternal Fixation with Synthes® Titanium Sternal Fixation System Using Preoperative 3-Dimensional Planning and a Patient-Specific Surgical Guide: A Pilot Study
2021
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 relatively 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.
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