Thorac Cardiovasc Surg 2017; 65(04): 325-331
DOI: 10.1055/s-0035-1549360
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Symptoms of Sternal Nonunion Late after Cardiac Surgery

Juha Hautalahti
1  Department of Cardiothoracic Surgery, Heart Center Co., Tampere University Hospital, Tampere, Finland
2  School of Medicine, University of Tampere, Tampere, Finland
,
Irina Rinta-Kiikka
2  School of Medicine, University of Tampere, Tampere, Finland
3  Department of Radiology, Tampere University Hospital, Tampere, Finland
,
Matti Tarkka
1  Department of Cardiothoracic Surgery, Heart Center Co., Tampere University Hospital, Tampere, Finland
2  School of Medicine, University of Tampere, Tampere, Finland
,
Jari Laurikka
1  Department of Cardiothoracic Surgery, Heart Center Co., Tampere University Hospital, Tampere, Finland
2  School of Medicine, University of Tampere, Tampere, Finland
› Author Affiliations
Further Information

Publication History

23 November 2014

16 February 2015

Publication Date:
24 April 2015 (online)

Abstract

Background A cohort of patients having symptoms of sternal nonunion late after sternotomy was studied to find out whether the complaints were related to true sternal nonunion or decreased bone density.

Methods A survey was mailed to 2,053 cardiac surgical patients operated in our institution between July 2007 and June 2010. The patients were requested about symptoms referring to sternal instability. A group of symptomatic individuals as well as 1:1 age- and time-matched asymptomatic controls were examined with sternal palpation, ultrasound during standardized sternal pressure provocation, and computed tomography (CT).

Results The number of patients replied in the survey was 1,918 (93.4%); 2.3% (44 patients) reported sensation of movement or clicking in sternum during body movements and during coughing. Symptomatic patients living within 200 km to the hospital (21) and their asymptomatic controls (21) were selected for further clinical and imaging studies. Mean period between the initial operation and the examinations was 36 (22–56) months. Sternal palpation pain was significantly associated with reported symptoms suggestive of sternal nonunion (odds ratio [OR] 22.0; 95% confidence interval [CI] 2.5–195); however, none of the patients had clinically unstable sternum or nonunion in the sternal imaging. The symptoms of sternal instability were more frequent in patients whose bone mineralization rate (as measured with T-scores) was higher.

Conclusion Symptoms suggestive of sternal nonunion were experienced by 2.3%. However, their symptoms did not correlate with CT scans or provocation ultrasound although palpation pain was evident. Thus the pain is derived from nonmechanical etiologies. Higher bone mineralization rate correlated with abnormal symptoms of sternal wound.

Funding

This work was supported by Tampere Tuberculosis Foundation, Hospital District.