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Objective <p>Wire fracture during sternal closure following median sternotomy poses significant risks, including sternal dehiscence. This study introduces and evaluates a novel “twist-to-writhe” technique aimed at reducing the risk of wire fracture while maintaining adequate sternal closure.</p> Methods <p>Ten foam sternum models per group were used and bisected to simulate median sternotomy. Each foam sternal model was closed with five sternal wires using either the twist-to-writhe (experimental) technique or the traditional (control) technique. In the twist-to-writhe method, wire ends that were cleaved were left at 10&#xa0;centimeters (cm) before twisting with a wire twister. In the traditional method, wire ends were cut to 1&#xa0;cm before twisting. Compressive forces at several sternal points were measured.</p> Results <p>The average compressive forces across four key sternal points were similar between the twist-to-writhe and traditional methods (167.45 ± 5.96 newton (N) vs. 172.92 ± 7.41 N, <i>p</i> = 0.086). No significant differences in force application were observed at the manubrium, upper mid-sternum, lower mid-sternum, or xiphoid process (<i>p</i> &gt; 0.05 for all comparisons).</p> Conclusion <p>The twist-to-writhe technique may reduce the incidence of wire fractures without compromising sternal approximation or closure quality. Further clinical validation is needed to confirm these findings.</p>

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Characterizing twist-to-writhe wiring technique for sternal closure following median sternotomy: biomechanical analysis

  • 期刊论文

  • 发表日期：

    2026年2月19日

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  • Peter Dong Won Cho,
  • Amba Viswanathan,
  • Leigham Breckenridge,
  • Katy Strand,
  • Michael Hast,
  • Uday Dasika

摘要

Objective

Wire fracture during sternal closure following median sternotomy poses significant risks, including sternal dehiscence. This study introduces and evaluates a novel “twist-to-writhe” technique aimed at reducing the risk of wire fracture while maintaining adequate sternal closure.

Methods

Ten foam sternum models per group were used and bisected to simulate median sternotomy. Each foam sternal model was closed with five sternal wires using either the twist-to-writhe (experimental) technique or the traditional (control) technique. In the twist-to-writhe method, wire ends that were cleaved were left at 10 centimeters (cm) before twisting with a wire twister. In the traditional method, wire ends were cut to 1 cm before twisting. Compressive forces at several sternal points were measured.

Results

The average compressive forces across four key sternal points were similar between the twist-to-writhe and traditional methods (167.45 ± 5.96 newton (N) vs. 172.92 ± 7.41 N, p = 0.086). No significant differences in force application were observed at the manubrium, upper mid-sternum, lower mid-sternum, or xiphoid process (p > 0.05 for all comparisons).

Conclusion

The twist-to-writhe technique may reduce the incidence of wire fractures without compromising sternal approximation or closure quality. Further clinical validation is needed to confirm these findings.