Failure of sternal wires depends on the number of turns and plastic deformation: Combined experimental and computational approach

Abstract

OBJECTIVES The number of turns at the end of a wire closure is not described or discussed in any cardiosurgical guidelines. The hands-on experience of the surgeon plays a significant role. The aim of this work was to clarify the relationship between the number of turns of the suture and the resulting strength of the sternal fixation. METHODS The study was performed in 2 independent steps. The first step was a finite element simulation, where the stress and strain distribution of the sternal fixation was observed. The second step included the experimental set-up and the statistical evaluation of the results. RESULTS Our study showed that the failure force rose linearly as the number of turns increased. The lowest average measured force was 370 N (3 turns); the highest was 430 N (7 turns). The failure modes were either untwisting of the wires or rupture of the closure, which is controlled by the number of turns. As the number of turns increases, superficial cracks can occur. CONCLUSIONS Based on our results, the 5-turn option is the best solution for the closure. The failure force is still double the value reported in the literature, so there is a high safety margin for failure. The failure mode is untwisting; hence, no unexpected fracture can occur, and there is still an elastic core in the cross-section of the wire.