Fractured Sternal Wires Post Coronary Surgery: A Cross-Sectional Study Examining Wire Configurations, Sternal Locations, and Breakage Sites.

BACKGROUND

Sternal cerclage is subject to wire fatigue and failure. A cohort of patients with previous coronary artery bypass grafting was evaluated to assess the prevalence, location, and risk factors for fractured sternal wires.

METHODS

A cross-sectional study was conducted to assess adult patients with previous left internal mammary artery bypass grafting who underwent cardiac catheterization from January 1, 2020 to May 27, 2025 at McGill University Health Centre (Montreal, QC, Canada). Chart review and angiographic analysis identified patients with previous median sternotomy closed with wires. Two researchers analyzed angiograms for wire configurations and fracture characterizations. Data were analyzed descriptively and quantitatively.

RESULTS

Of 639 post-coronary surgery patients in this cohort (mean angiographic follow-up: 12.1 [SD 8.8] years after surgery), 174 (27.2%) patients had fractured sternal wires, totaling 271 fractured wires (5.8% of all wires). Significant independent risk factors were body mass index (odds ratio [OR], 1.05 per kg/m2; P = .002), male sex (OR, 2.19; P = .007), and time between surgery and angiography (OR, 1.04 per year; P = .001). Fracture rates were 1.7% (P < .001) for multitwist, 5.7% (P = .96) for simple interrupted, and 8.6% (P = .003) for figure-of-8 configurations. The most inferior sternal body wires and most superior manubrial wires had the greatest fracture rates, with 17.2% (P < .001) and 7.4% (P = .002), respectively. The most common breakage site was where wires bend around the sternum (46.9%).

CONCLUSIONS

Sternal wire fractures were frequent. Breakages were least common among multitwist wires and most common among figure-of-8 configurations, at sternal endpoints, and at wire bends. Future studies should investigate clinical implications of fractured wires.