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Sternal Fixation With Synthes® Titanium Sternal Fixation System Using Preoperative 3-Dimensional Planning and a Patient-Specific Surgical Guide.
  • Filip Haenen,
  • Roemer Vos,
  • Edgar Daeter
Filip Haenen
Sint Antonius Ziekenhuis
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Roemer Vos
Sint Antonius Ziekenhuis
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Edgar Daeter
Sint Antonius Ziekenhuis
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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.