Sternal closure with rigid plate fixation versus wire closure: a randomized controlled multicenter trial.

BACKGROUND: Rigid bone fixation is the standard of care for all bone reconstructions except that after sternotomy. Sternal reconstruction after median sternotomy using rigid fixation with plates may improve bone healing and reduce pain when compared with wire cerclage. METHODS: One-hundred forty patients at six centers who were determined preoperatively to be at high risk for sternal wound complications were randomly assigned to sternal closure with rigid plate fixation (n=70) or wire cerclage (n=70). Sternal healing was evaluated at 3 or 6 months by a core laboratory using computed tomography. Pain and function were evaluated at postoperative day 3 through discharge, 3 weeks, 6 weeks, 3 months, and 6 months. RESULTS: Sternal healing was superior in rigid plate fixation patients at both 3 and 6 months. Mean computed tomography scores in the rigid plate fixation and wire cerclage groups at 3 months were 1.7±1.1 and 0.9±0.8 (p=0.003). At 6 months, the scores were 3.2±1.6 and 2.2±1.1, respectively (p=0.01). At 6 months, 70% of rigid plate fixation patients had achieved sternal union, compared with 24% of conventional wire cerclage patients (p=0.003). Pain scores and narcotic usage were lower in rigid plate fixation patients. Significant differences in pain scores were observed at 3 weeks for total pain (p=0.020) and pain with coughing (p=0.0084) or sneezing (p=0.030). Complication rates were similar in both groups. CONCLUSIONS: Sternal reconstruction using rigid fixation with plates improved bone healing and reduced early postoperative pain compared with wire cerclage.

Polyvinylpyrrolidone modified bioactive glass fibers as tissue constructs: in vitro mesenchymal stem cell response.

The sol-gel synthesis of a bioactive glass (BAG) sol with the incorporation of polyvinylpyrrolidone and the subsequent spraying of short, discontinuous fibers is reported. The incorporation of the polymer into the BAG sol allowed for increased control of the rheological properties and resulted in a more homogeneous fibrous material when sprayed through an air gun. Reaction kinetics and sol viscosity were monitored and analyzed during synthesis, and fibers were characterized using scanning electron microscopy and thermal analysis. Fibers were sintered at 900 degrees C and were examined for in vitro bioactivity in a simulated body fluid solution. The presence of hydroxyapatite crystals is confirmed by examination with scanning electron microscopy, energy dispersive X-ray spectroscopy (EDX), and X-ray diffraction (XRD). Both the proliferation rate and cell density of rat mesenchymal stem cells cultured on BAG fiber constructs of varying porosities were shown to be dependent upon fiber spacing.