3. Indications
S Osteotomy : fixation of ribs and sternum after
thoracothomy
S Osteosynthesis : fixation of ribs and sternum
after traumatic fracture, sternal closure
S Bone grafting
Staff Training UZ Leuven, March 23
4. Material characteristics
S Bioabsorbable bone fixation device for ribs and
sternum
S PLLA ( Poly-L-Lactic-Acid )
S PLLA reacts with water by hydrolysis and is finally
metabolized to water and carbon dioxide
Staff Training UZ Leuven, March 23
7. Bioabsorbability
1. Molecular weight is reduced and then bending
strength is decreased ( T1/2 = 4-6 months )
2. Weight decreases and completes the
degradation process
3. PLLA completely dissolved after 3 years
Staff Training UZ Leuven, March 23
8. Bending Strength
Staff Training UZ Leuven, March 23
0 200 400 600 800 1000 1200
チタン合金
ステンレス(SUS316)
ヒト皮質骨
グランドフィックス
Bending strength (MPa)
GRAND FIX
Human Cortical Bone
Stainless Steel (SUS316)
Titanium
Close value to human cortex bone
9. Product line : rib pin
Length
Width
Depth
Staff Training UZ Leuven, March 23
14. Rib pin
Create a 2 cm space between each rib bone and hold them with
surgical suture
Staff Training UZ Leuven, March 23
15. Rib pin
Use the dedicated sizer to perform a hole of same depth at both
sides of rib bones
Staff Training UZ Leuven, March 23
16. Rib pin
Use the appropriate clamp to pick and insert the pin into the bone.
The green line denotes the midpoint of the pin
Staff Training UZ Leuven, March 23
17. Rib pin
Put surgical sutures 2 cm from the cut line
Staff Training UZ Leuven, March 23
18. Sternum pin
Identify the point of insertion of the pin
Place the dedicated reamer vertically and drill a hole on both
sides
The hole shoudn’t be larger than the diameter of the pin
3mm2mm
19. Sternum pin
Insert the dedicated sizert into the holes until the target line ( marked on
the sizer ) meets the size of the pin
Use side ② for eventual enlargement of the hole
The sizer shoudn’t be rotated in order not to create too large holes
② same sized side
product number is marked on
this side
① smaller sized side
20. Sternum pin
Grip the pin with the dedicated clamp
If the pin has a blue mark on its center, grip it on the line
If the pin has a curvature, adjust the pin’s curvature to bone’s
curvature
red arrow shows curvature of the pin
21. Sternum pin
Pull toward each divided bone and insert the pin in each hole
Complete usual chest closure
24. Advantages
Adult patients vs. wires
S Prevention of sternum and periosteum from rubbing
S Reduction of pain, infection and inflammation of the
wound area
S Complete absorption
25. Advantages
Children vs. wires
S Bone union process is 20 – 30 % faster. Percentage of
costal cartilage is higher.
S Decrease of malunion and chest deformity
S Radiolucency of the sternum pin ( invisible to X-Ray )
27. Clinical litterature
Sternal Closure With Reabsorbable Pin and Cord in
Pediatric Less Invasive Cardiac Surgery
H. Oiwa, R. Ishida and K. Sudo
Ann Thorac Surg. 2004; 78: 358–9
