Breastbone Fracture after Heart Surgery
What causes the breastbone to split apart after heart surgery?
"We must stabilize the chest bone much better to prevent dehiscence [wound separation] and life-long instability due to non-bone-union."
That was what leading physician Dr. Hans Jonsson, Department of Cardiothoracic Surgery and Anesthesiology at Karolinska University Hospital, said at the Symposium of Cardiothoracic Surgery held in Zürs, Austria, in March 2013.
He was reporting on the results of a study held at the Karolinska University Hospital between 2011 and 2012. The following is a partial summary of his talk.
Understanding potential wound separation after open heart surgery
Generally, only stainless steel wires are used to hold the two sternum halves together. They are very thin, only 1-2 mm in diameter. If the patient moves, coughs or sneezes, the wires cut into the bone on either side creating a space in the middle and preventing the bone from healing properly.
The result is lifelong non-bone-union. This enormously jeopardizes the quality of living for those suffering from it.
Sternal dehiscence (space between the cut sternum halves) is a major cause of morbidity and mortality after cardiac surgery.
Sternal dehiscence (space between the cut sternum halves) is a major cause of morbidity and mortality in cardiac surgery.
The problem is worse for obese people, and those with COPD
For those suffering from obesity, the problem is worsened. Additional weight pulls the wires apart that should be holding the sternum together.
Sufferers of COPD (Chronic Obstructive Pulmonary Disease)—the most common type of pulmonary disease among smokers—which leads to severe bouts of coughing, can sometimes cough so hard that the wires break, ripping the chest bone apart.
Both of the above cases can increase hospital stays by 5 or 6 times, from 7 to 40 days. In monetary terms, the cost goes from €20,000 to a staggering €75,000.
The most important factor to consider with sternum fractures is that the bone moves all the time. Every breath creates friction in the incision area and can cause inflammation. The technical term for this inflammation is mediastinitis.
The solution is the medically proven Posthorax vest
The greatest tragedy of the above is that it is entirely preventable. Karolinska University Hospital began using the Posthorax vest and showed a reduction of mediastinitis frequency from 2.2% to 0.6% during the clinical study.
The frequency of atelectasis—partial or entire collapse of the lung, or of a part of the lung—was also significantly lower.
Physiotherapists using the vest at the Karolinska University Hospital reported that patients were much easier to mobilize and had less pain. The average hospitalization time also decreased by one day over all patients.
Since these clinical trial findings, Karolinska University Hospital recommended using the Posthorax vest to significantly reduce the risk and suffering for the patient and his or her family members, as well as sharply decrease the costs for the hospital.
