Once open-heart surgery is complete, the surgical team faces a task that is often underappreciated: putting the sternum back together securely enough to heal properly while the patient breathes, coughs, and moves for weeks afterward. Sternal closure has traditionally relied on stainless steel wire cerclage, but rigid plate fixation has become a more visible alternative in recent years. Neither method is universally correct; the choice depends on the patient's risk factors, the surgeon's assessment, and institutional practice.
How Does Wire Cerclage Work?
Wire cerclage closure involves passing stainless steel wires through or around the sternal halves and twisting them to compress the bone edges together, typically in a series of loops along the length of the sternotomy. This technique has been used for decades, is familiar to virtually every cardiac surgical team, and does not require specialized instrumentation beyond standard wire and wire twisters. Wires distribute closing force across multiple points along the sternum, which works well for many patients but can allow micromotion at the bone edges in cases where the sternum is unusually fragile or the patient generates high mechanical stress on the closure, for example through severe coughing.
What Does Rigid Plate Fixation Involve?
Rigid plate fixation uses titanium or titanium alloy plates secured across the sternal halves with screws, distributing load more like an internal fixation system used elsewhere in orthopedic surgery. Because the plates span the sternotomy and are rigidly screwed into bone on both sides, this approach is designed to reduce the small movements at the bone interface that can occur with wire closure, which may support more stable healing conditions in appropriately selected patients. Plate systems generally require more dedicated instrumentation for plate contouring and screw placement compared with wire closure, and add material cost to the case.
Which Patients Might Benefit From One Approach Over the Other?
Surgeons often consider rigid plating in patients thought to carry higher risk for sternal complications, such as those with osteoporotic bone, diabetes, obesity, chronic steroid use, or a history of sternal wound problems, since these factors are associated with a higher reported risk of dehiscence or nonunion. Standard wire cerclage remains a well-established, effective option for many patients without these risk factors. The decision ultimately rests with the operating surgeon, who weighs the patient's bone quality, comorbidities, and the specifics of the sternotomy against the added complexity and cost of a plating system.
Does One Method Lead to Faster Healing?
Both approaches aim for the same biological endpoint: bony union of the sternum, which generally takes several weeks to consolidate regardless of the fixation method used. Some published literature has examined whether rigid fixation is associated with lower rates of sternal complications in specific high-risk populations, but outcomes are influenced by many variables beyond the closure method itself, including infection control, patient nutrition, and postoperative activity restrictions. Neither wire nor plate closure guarantees a particular healing timeline for an individual patient, and comparisons should be interpreted as general trends rather than predictions for any one case.
What Do Patients Notice Differently Between the Two?
From a patient's perspective, the external experience, chest tenderness, sternal precautions limiting heavy lifting, and gradual return to normal activity, tends to look similar regardless of which internal fixation method was used. Rigid plates are sometimes palpable or occasionally visible on chest X-ray as a permanent radiographic finding, which patients may notice and ask about at follow-up visits. Neither wire nor plate hardware typically needs to be removed unless a specific complication develops. More background on fixation devices used in cardiac surgery is available on the cardiac surgery instruments category page.
Can sternal wires or plates be seen on airport security scanners?
Metal sternal hardware can sometimes trigger metal detectors at airport security. Patients with any implanted metal hardware are generally advised to inform security personnel, and many surgical teams provide documentation of the implant for this purpose.
Device availability and regulatory status vary by country. Please contact INVAMED or your authorized local distributor for current regulatory information applicable to your region.