Sternal Nonunion and Instability
The sternum, also known as the breastbone, is located over the heart and is an important part of the chest wall. It protects the heart from injury, and joins the ribs from both sides of the chest. It also stabilizes the arms via connections to the shoulder. During heart surgery, the sternum is split to provide access to the heart. The sternum must be wired back together after the surgery is complete to facilitate proper healing.
During the healing phase after surgery, the wired sternum is vulnerable to the expansion of breathing muscles. This movement can loosen the wires over time. Too much activity or violent sneezing or coughing before the sternum is completely healed can result in incomplete healing of the two sides of the bone. Improper healing of the sternum occurs in approximately two to three percent of cardiac patients. This is referred to as sternal nonunion and instability. This condition leaves patients with an unstable chest wall that can be painful or uncomfortable. Sternal nonunion is most common following cardiac surgery, but may also occur following trauma or other thoracic surgery.
Untreated sternal instability can result in continued pain, the possibility of infection and a permanent delay in the healing of the sternum. Chest wall stabilization helps prevent the negative symptoms associated with sternal nonunion.
What are the Symptoms of Sternal Nonunion and Instability?
Following heart surgery, improper healing of the breastbone may cause:
- Clicking/clunking sensation
- Popping or grinding
- Unstable feeling in the chest
- Rib cage movement abnormality when the person breathes (each side of the rib cage moves separately)
These symptoms can manifest both during physical activity and activities of daily living, such as reaching, rolling over in bed or getting up from a sitting position. If these symptoms persist longer than three months, it is recommended to see your surgeon in order to determine the possibility of sternal nonunion and instability. If your surgeon deems it necessary, you will then be referred to a qualified specialist for repair.
Chest Wall Stabilization
Dr. Michael Rose at The Institute for Advanced Reconstruction specializes in chest wall stabilization. He has been performing this procedure for over 10 years. This surgery uses titanium metal plates to bridge the fractured bone and give it the much-needed stability it lacks. Chest wall stabilization is much less invasive than the heart surgery from which the problem originated. In fact, the plastic surgeon does not enter the chest cavity at all to repair the bone. The procedure is performed just under the skin and muscle layer, on top of the ribs and breastbone.
Advancements in research have identified the benefits of using steel or titanium plates for this procedure. These plates, which replace the past use of wires, secure the breastbones together in the proper position much more effectively than wires. This allows for an improved alleviation of symptoms and proper healing of the bone. The newer plates used in surgery also allow for smaller incisions and quicker recovery times.
This procedure typically takes one hour depending on the nature of the case and is done under general anesthesia. It requires only a one-day hospital stay. Basic recovery takes three to four weeks. Recovery for lifting and other strenuous physical activity takes four to six weeks.
Chest wall stabilization has been shown to result in low recurrence and complication rates. In a review of treatments for sternal nonunion and instability in the Annals of Plastic Surgery published in January 2005, all subjects who underwent the above mentioned procedure experienced a successful outcome. The pain was completely resolved in all patients, wounds healed to completion and there was no incidence of subsequent infection. Dr. Rose has had similar success rates in his experience treating this problem.
Evaluating Eligibility for Surgery
Patients suffering from sternal nonunion and instability should schedule a consultation with Dr. Michael Rose at The Institute for Advanced Reconstruction. During your appointment, he will assess the chest wall dynamics, including a physical exam and X-rays, and provide a diagnosis and possible treatment options.
As with many of the conditions treated at The Institute for Advanced Reconstruction, chest wall instability often goes undiagnosed. Those who suffer from it may relay symptoms to their physicians, but often are not provided a long term treatment option. Thus, the prolongation of symptoms with no identified treatment options can result in understandable anxiety and depression. Learning about the treatment options that are available will not only provide a patient with physical pain relief, but may also alleviate their psychological symptoms as well.
About Dr. Michael Rose
Dr. Michael Rose has spent much of his career helping those who have failed to find relief for various conditions. Among his area of expertise, he has been performing chest wall stabilization surgery for over a decade. In his experience thus far, nearly 100 percent of patients have experienced healing of chest wall instability.
One of Dr. Rose’s patients was particularly inspirational. This 65-year-old man was excited to return to his beloved game of golf following cardiac surgery. However, upon swinging his golf club, he noticed a clicking sound whenever his chest bone moved. At first, it was just bothersome, but slowly became uncomfortable and then downright painful. Eventually, the patient had to stop playing golf. That’s when he found Dr. Rose, and he was anxious to see if he could help him. Dr. Rose and his team were able to plate his sternal bone, which went on to fully heal. The patient is now happily back playing golf without any pain.
To explore if you may be a candidate for this procedure, contact The Institute for Advanced Reconstruction today for an appointment.