Evaluation of Primary Plating in Sternotomy Patients for Osteosynthesis and Pain

Study Overview
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Brief Summary
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The goal of this study is to evaluate sternal osteosynthesis, chest wall pain and return to normal activity in open heart surgery patients who had their breast bone closed either with wires or plates.

Detailed Description
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Median sternotomy patients will be randomized to either wire or rigid fixation groups. A scheduled evaluation period will record clinical parameters. Enrollment has ended with one hundred forty (140) patients.

Official Title
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A Prospective, Randomized-Controlled, Multicenter Study Evaluating Primary Plating in High-Risk Median Sternotomy Patients for Osteosynthesis and Pain

Conditions
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Sternal Wound Infection, Sternal Non-union, Pain, Mediastinitis

Intervention / Treatment
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* Device: SternaLock Rigid Fixation Plates
* Device: wire (control)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients undergoing median sternotomy; Patients eighteen (18) years of age or older; Patients presenting two or more risk factors such as diabetes mellitus, Chronic Obstructive Pulmonary Disease, obesity (BMI > 30), osteoporosis, Renal failure, Chronic steroid use, Immunosuppression, Redo sternotomy, Neurologic dysfunction severely affecting ambulation, Off mid-line sternotomy bilateral IMA use Long cardio-pulmonary bypass runs Transverse fractures of the sternum Exclusion Criteria: Patients with a non-standard sternotomy; Patients with an off-midline sternotomy that reduced the bony margin to <2mm Patients under eighteen (18) years of age; Patients that are pregnant or currently lactating; Patients presenting intra-operative conditions that would require the use of rigid fixation and/or additional post-sternotomy mechanical support beyond wire cerclage due to surgical evaluation, Patients defined within the New York Heart Association (NYHA) or Canadian Cardiovascular Society (CCS) functional Class IV for congestive heart failure, Patients presenting emergent/salvage cardiac acuity as defined per the Society of Thoracic Surgeons (STS) guidelines: i.e., patients undergoing cardiopulmonary resuscitation en route to the operating room or prior to induction of anesthesia; Patients undergoing post-operative revision procedures that treat the original sternotomy in such a way as to affect outcome (antibiotic irrigation, debridement or other treatment to the osteotomy); Patients unwilling or unable to return for follow-up; Lacking the ability to follow instructions; Intraoperative death.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: wire (control)<br>patients will have their sternum closed using wire (stainless steel surgical wire). | Device: wire (control)<br>* patients will have their sternum closed using wire (stainless steel surgical wire).<br>|
| Experimental: SternaLock Rigid Fixation Plates<br>patients will have their sternum closed by rigid fixation using SternaLock Rigid Fixation Plates. | Device: SternaLock Rigid Fixation Plates<br>* patients will have their sternum closed by rigid fixation using SternaLock Rigid Fixation Plates<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| CT Scan Evaluation of Sternal Bone Healing | Quantitative evaluation of sternal bone healing at 5 anatomical locations along the sternum using a 6 point quantitative scale (0= no healing and 5= complete healing) | 3 and 6 Months | 
| Activity Based Total Visual Analog Pain Score | Postoperative VAS pain scores (scale of 0-10 for each; 0= no pain, 10= worst pain imaginable) were evaluated as a function of resting, coughing, sneezing and general movement. The sum of these was used to derive an Activity Based Total Visual Analog Pain Score, (scale of 0-40; 0= no pain, 40= worst pain imaginable). For this primary endpoint analysis, the total score at 6 months was evaluated. | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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open heart surgery