Abstract Objective Median sternotomy, the standard approach in cardiothoracic surgery, presents ongoing challenges in postoperative closure and healing. Osteoporosis, osteopenia, and advanced age weaken bone increasing risks of instability and non-union. Respiratory motion, coughing, and chronic lung disease further compromise stability. Optimal closure must balance mechanical stability, biologic healing, infection prevention, and re-entry possibility. Hemostatic agents such as bone wax or adhesives may assist with bleeding control but impair osteogenesis or increase infection risk if overused. These studies evaluated whether augmenting sternal plate or wire fixation with a biologic allograft improves stability and outcomes through finite element analysis (FEA), cadaveric biomechanical testing, and retrospective clinical review. Methods FEA and cadaveric testing were conducted to assess biomechanical performance. FEA models of an average adult male sternum, based on CT scans were subjected to shear, torsion, and lateral tension to simulate physiologic stress. Two experienced cardiothoracic surgeons performed eight cadaveric closures each—four standard and four augmented with a biologic graft (total = 16). Specimens were tested using an Instron E-10000 dynamic frame with OptiTrack motion capture under physiologic loads. Key outcomes included displacement, stffness, and failure at ≥ 2 mm separation. A retrospective review of 44 patients who receivedallograft-augmented sternal closure recorded demographics, comorbidities, fixation methods, imaging, and outcomes. Endpoints were infection, stability, reoperation, pain, and early mobilization. Results FEA showed that wire and titanium plate fixation augmented with a biologic graft significantly reduced sternal displacement under longitudinal and lateraltension compared with standard fixation alone. Addition of a median biologics improved load distribution and shear resistance. Cadaveric testing confirmed greater construct stiffness in graft-augmented groups. Clinically, 44 patients (52% male; mean age 74 years) were analysed. Primary diagnoses included multivessel CAD (42%), NSTEMI (8%), severe mitral regurgitation (8%), and severe aortic stenosis (8%). Comorbidities were hyperlipidemia (21%), hypertension (20%), and type 2 diabetes (10%). No reoperations or infections occurred. Rigid fixation was used in 98% of cases, with local vancomycin in 5%. At 4 weeks post-operation, 82% reportedVAS 0 and 18% VAS 1 pain scores. Conclusion Biologic augmentation of sternal fixation enhances mechanical stability and supports safe, rapid recovery with low complication rates. This combined biomechanical and clinical study supports further investigation into biologically reinforced closure methods for sternotomy patients. This abstract is funded by: None
Williams et al. (Fri,) studied this question.