SternaLock Blu
FEA
FINITE ELEMENT ANALYSIS computerized method for predicting how a product reacts to real-world forces, vibration, heat, fluid flow, and other physical affects
what are sterna lock blu plates made of
IV titanium
Emergency screws
Magenta 2.7mm self-tapping
what cut is the MICS for?
T cuts ONLY
design for screws to increase pull-out strength
accomplished by having larger threads at an angle and depth to maximize purchase into cancellous bone
at what months in the restore study did the patients receive ct scan
at 3 OR 6 months, NOT both
greater thread pitch?
bigger gap between threads
what study said wire pull through with the force of coughing?
cadaver study
in what study was there a plated sternum fail?
cadaver study, due to rib fracture or intercostal tearing
why can't the wires or plates touch?
corrosion, two metals interacting
objective of "sternal closure with rigid plate fixation versus wire closure: a randomized controlled multi center trial"
evaluate sternal bone healing and pain in patients with multiple risk factors undergoing open heart surgery via a median sternotomy
restore study objective
evaluate sternal bone healing and pain in patients with multiple risk factors undergoing open heart surgery vis. a median sternotomy
what does FEA show
finite element analysis shows whether a product will break, wear out or work the way it was designed
SternaLock Blu indication
intended for us in the stabilization and fixation of fractures of the anterior chest wall including -sternal fixation following sternotomy and reconstructive surgical procedure to promote fusion 1. sternal closure following variety of open heart surgeries 2.sternal revisions 3.Primary/Secondary traverse fracture fixation 4. Rib fixation
cadaver study looked at lateral...
lateral distraction, rostro-caudal shear, and anterior/posterior ahead using a pneumatic test
how do you measure sternum during MICS?
measuring caliper
rigid fixation results in superior...what study talks about animals
mechanical stability and fixation compared to wire circlage ...important of sternal approximation and mechanical stability in bone healing
MICS
minimally invasive closure system
how to ensure full approiximaiton of transverse sternotomy?
rostra-caudal alignment of superior sternotomy
up down alignments
rostro/caudal
what does grater threw distance in a screw accomplish?
slows for less bone displacement
chamfered edges
smooth
what pattern to insert screws
star or cross pattern
main points of restore
sternal healing was superior in rigid plate fixation patients at both 3 and 6 month -complication rates similar between groups -25% reductio in pain and narcotic usage
science behind rigid sternal fixation purpose
tell the story of rigid fixation FEA talks about RESTORE study-sternalock resulted in superior bone healing compared to wire cerclage in a prospective randomized trial.
the science behind rigid sternal fixation
the purpose of the paper is to tell the story of rigid sternal fixation
sternal closure with rigid plate: randomized controlled multi center trial" .. did they have more complications or less than wire cerclage?
the same complication rates, BUT plates had a 25% reduction in pain, narcotic use and 70% of rigid fixation patient achieve stern union vs 24% at 6 months
FEA study
the science behind rigid sternal fixation
paper with FEA
the science behind rigid sternal fixation
locking mechanism screw head
the smaller threads under the screw head are the locking mechanism
what are sterna lock blu screws made of
titanium alloy
A cadaveric, biomechanics analysis of sternal fixation systems objective
to compare the mechanical performance of rigid fixation vs- wire cerclage in cadavers sternum
cadaveric study details
using rigid plate fixation in two different configuration compared to writing using 3 trans-sternal and 5 peri-sternal wires.
main talking points of "sterna approximation and mechanical stability in bone healing"
wire work at approximating but do not provide mechanical stability. wire technique makes no difference plates provide enhanced mechanical strength and stiffness, which supports bone healing
can sternalock be used with osteoporosis?
yes
gold screws sternalock
-2.4mm -self-drilling lengths: 8, 10, 12, 14, 16, 18, 20
sterna lock blu screw design
-designed for cancellous bone to increase pull-out strength
"The Importance of Sternal Approximation and Mechanical Stability in Bone Healing' objective
-establish the role that approximation and rigid fixation play in bone healing -introduce CT scans to demonstrate the differences in bone healing seen between plates and wires. talks about animals
12 steps technique for plating
1. Expose sternum 2. Completed Mid-Line Sternotomy 3. Complete surgical procedure 4. assess bone and mark transverse fractures 5. Measure sternal depth where plate placement will occur and record measurements 6. wire the manubrium and zypohoid to reduce the top and bottom of the sternum 7. compete the full approximation by placing reduction forceps at the mid-boy 8. direct soft tissue from surface of sternum 9. select plate/screw configuration 10. contour partes as needed to ensure they lay flat on the sternum 11. fixate plate, inserting screws in a star pattern 12. seat screws and complete chest closure
4 step MICS procedure
1. approximate superior stern atomy with wires, and then use hexagon plate and appropriate length screws to stabilize the manubrium 2. The assemble device: lay the MICS plate on flat surface and position the instrument footplate int eh center of the plate. Turn the locking set screw clockwise with the manual driver to secure the plate to the instrument. 3. Postion plate inferior of the transverse sternotomy and implant screws. Pull the instrument superior to approximate transverse and implant remaining screws. 4. Continue pulling on the instrument until all screws have been implanting.
SternaLock Blu vs. wires
1. increased strength and stiffness 2. increased mechanical stability 3. reduced sternal separation 4. superior bone healing 5. reduced pain and narcotic usage
Plates profile
1.6mm
how many patients in the restore study
146
profile plate with screw
2.4
if a doctor is using a ruler to measure sternum how many mm do you add
2mm
separation of more than ..... can lead to non-union
2mm
plate for mini-thoracotomatie
4/8 hole straight plate
plate to use in mini-sternotomies
8 hole JL plate