Novel adhesives for sternal fixation and stabilization: A biomechanical analysis. (February 2019)

• Record Type: Journal Article
• Authors: Mehrvar, Cina; Kuzyk, Paul; Cohen, Gideon; Safir, Oleg; Zalzal, Paul; Alhalawani, Adel; Towler, Mark R.; Papini, Marcello
• Is Part Of: Clinical biomechanics. Volume 62(2019)
• Page Start: 66
• Page End: 71
• Publication Date: 2019-02
• Subjects: Adhesives -- Glass polyalkenoate cements -- Biomaterials -- Sternal closure -- Sternal wound infection -- Sternotomy; Biomechanics -- Periodicals; Osteopathic medicine -- Periodicals; Biomechanics -- Periodicals; Osteopathic Medicine -- Periodicals; 612.76
• DOI: 10.1016/j.clinbiomech.2019.01.007
• Languages: English
• ISSNs: 0268-0033

Abstract

Abstract: Background: Cerclage wires remain the current standard of care following median sternotomy, despite significant complications including dehiscence and infection. This study uses a human cadaveric model to investigate the use of glass polyalkenoate cements formulated from two glasses, A (mole fraction: SiO2 :0.48, ZnO:0.36, CaO:0.12, SrO:0.04) and B (mole fraction: SiO2 :0.48, ZnO:0.355, CaO:0.06, SrO:0.08, P2 O5 :0.02, Ta2 O5 :0.005), to improve wired sternal fixation. Methods: Median sternotomies were performed on fifteen cadaveric sterna. Fixation was performed with either traditional wire cerclage or adhesive-enhanced wire cerclage; the adhesive based on either Glass A or Glass B. Cyclic tensile loading of 10 N to 100 N was applied. Every 30 cycles, the maximum load was increased by 100 N up to a maximum of 500 N. Two adhered sterna were tested beyond 500 N. Mid-sternal displacement was measured to assess fixation stability. Findings: Displacement for adhesive-enhanced sternal closures were significantly less ( p < 0.05) than standard wire cerclage. There was no significant difference between adhesives. Up to 500 N, no adhesive-enhanced sternum experienced a pathological sternal displacement (>2 mm), while three out of five of traditional wire fixations did. Of the two adhered samples tested beyond 500 N, one showed pathological displacement at 800 N and the other at 1100 N. Failure of adhered sterna appeared to initiate within the trabecular bone rather than in the adhesive. Interpretation: The adhesives were capable of providing immediate bone stability, significantly reducing sternal displacement. In vivo investigations are warranted to determine the effect the adhesives have on bone remodelling. Highlights: Novel adhesives investigated to improve on current sternal closure techniques Biomechanical testing, using a cadaveric model, performed on adhesives Midline displacement found to be significantly less using adhesive over wires