Novel adhesives for sternal fixation and stabilization: A biomechanical analysis

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, P2O5:0.02, Ta2O5:0.005), 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 10N to 100N was applied. Every 30cycles, the maximum load was increased by 100N up to a maximum of 500N. Two adhered sterna were tested beyond 500N. 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 500N, no adhesive‐enhanced sternum experienced a pathological sternal displacement (>2mm), while three out of five of traditional wire fixations did. Of the two adhered samples tested beyond 500N, one showed pathological displacement at 800N and the other at 1100N. 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. HIGHLIGHTSNovel adhesives investigated to improve on current sternal closure techniquesBiomechanical testing, using a cadaveric model, performed on adhesivesMidline displacement found to be significantly less using adhesive over wires