Sternal instability measured with radiostereometric analysis. A study of method feasibility, accuracy and precision

Rikke Falsig Vestergaard, Kjeld Søballe, John Michael Hasenkam, Maiken Stilling, Rikke Falsig Vestergaard, Kjeld Søballe, John Michael Hasenkam, Maiken Stilling

Abstract

Background: A small, but unstable, saw-gap may hinder bone-bridging and induce development of painful sternal dehiscence. We propose the use of Radiostereometric Analysis (RSA) for evaluation of sternal instability and present a method validation.

Methods: Four bone analogs (phantoms) were sternotomized and tantalum beads were inserted in each half. The models were reunited with wire cerclage and placed in a radiolucent separation device. Stereoradiographs (n = 48) of the phantoms in 3 positions were recorded at 4 imposed separation points. The accuracy and precision was compared statistically and presented as translations along the 3 orthogonal axes. 7 sternotomized patients were evaluated for clinical RSA precision by double-examination stereoradiographs (n = 28).

Results: In the phantom study, we found no systematic error (p > 0.3) between the three phantom positions, and precision for evaluation of sternal separation was 0.02 mm. Phantom accuracy was mean 0.13 mm (SD 0.25). In the clinical study, we found a detection limit of 0.42 mm for sternal separation and of 2 mm for anterior-posterior dislocation of the sternal halves for the individual patient.

Conclusion: RSA is a precise and low-dose image modality feasible for clinical evaluation of sternal stability in research.

Trial registration: ClinicalTrials.gov Identifier: NCT02738437 , retrospectively registered.

Keywords: Bone healing; Sternum; Wound healing.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by The Danish Ethics board as it adheres to the Helsinki Declaration and all participants gave their informed consent to participate in this study with the intent to publish.

Competing interests

No financial support was given to this project and there are no conflicts of interest for any of the authors.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Schematic drawing of axes relating to the anatomy of the sternum
Fig. 2
Fig. 2
Photograph of the sternal sawbone after median sternotomy and with wire-cerclage placed in the custom-made fixture device

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