Seperated sternum post open heart. Has anyone heard about this?

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valentine
New Member


Date Joined Mar 2006
Total Posts : 8
   Posted 4/1/2006 12:04 PM (GMT -7)   
Post open heart surgery my sternum did not fuse, the wires snapped also.  Then I returned for another rewiring procedure and it failed also.  They used a more durable and strong wire and yet they still broke.  As a result my sternum did not fuse or heal together.  Has anyone ever had this problem.  Please respond. 
Thanks guys

els
Veteran Member


Date Joined Oct 2005
Total Posts : 4031
   Posted 4/1/2006 12:24 PM (GMT -7)   

Hi valentine,  Welcome to Healing Well forum. 

All I can say is wow!!  I cant imagine going through that.  I am so sorry.  I only have a pacemaker that I keep pulling the wires out of...and that is painful enuf.  What are the doctors going to do now?  Is there anything that they can do?


~elisha~ 
 
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Aldo
Regular Member


Date Joined Jan 2006
Total Posts : 289
   Posted 4/2/2006 11:10 AM (GMT -7)   

So sorry to hear of these problems. I have heard of them before. I do know that people with diabetes, or who are obese, are more susceptible to separation of the sternum.

There is lots of information on the web about this subject. If they have to, I think they can put in a metal plate!

Here is an excerpt I found with a doctor answering questions about sternal healing and separation: 

--------------------------------------------------

Response to questions by Dr.J.F.Morin

Chest Pain Post open Heart Surgery
Most patients undergoing open heart surgery for a congenital defect, valve repair or replacement or coronary artery bypass will have incisional pain that subsides gradually over the first month post-surgery. This pain is aggravated by coughing, sneezing, rotation of the chest or elevation of the arms. Due to the fact that they lie on their back for quite a while (4-5 hours in the operating room and 12-24 hours in the intensive care unit) the patients complain of thoracic and lumbar back pain that resolves within two to three weeks. Shoulder pain irradiating to the arms and fingers is not unusual. This is related to over stretching of brachial nerves while opening the sternum to perform the surgery. The incisional sternal pain is described as an ache. Many patients report a sensation of numbness on the left side of their chest which results from the dissection of the internal mammary artery. Some patients can barely wear a shirt for a few weeks following their surgery due to a hyperesthesia over their sternal skin. Fortunately, all these malaises subside within 1 or 2 months post surgery.
In a small number of cases, the sternal pain is out of proportion or persists beyond the expected recovery period. In these patients, a wound complication such as sternal dehiscence or infection has to be ruled out. Sternal dehiscence and/or infection is rare (2-5%) but dreadful for the surgeon and patient. Dehiscence of the sternum is usually, but not necessarily, secondary to infection. The infection prevents the bone healing process and leads to mediastinitis and sternal instability. These patients are usually septic and require urgent debridement of the infected and necrotic bone and reclosure of the sternum and/or a muscle flap to cover the bone defect. Some predisposing factors leading to this complication have been identified such as obesity, diabetes, patients with chronic obstructive pulmonary disease requiring prolonged ventilation post-operatively and patients where both mammary arteries were used. In older patients with osteoporotic bone, the sternal wires may cut through the bone and lead to dehiscence without fever. These patients complain of "clicking" sternum or sternal pain while turning, coughing or elevating their upper extremities. This pain is bearable but annoying for most patients. One option for the patient is to live with this unstable sternum. The pain subsides with time but may come back while the patient is participating in strenuous exercise. However, this condition never compromises the cardiac or pulmonary function of the patient. the other option is to rewire their sternum. Occasionally, the persistent pain arise from non-union of a broken rib, dislocation of a costo-chondral junction, or a subcutaneous stitch or wire. Other causes have to be ruled out in cases of persistent chest pain post open heart surgery. A small proportion of patients (10%) have closure of a coronary artery graft with recurrent angina. This condition is usually quite well identified by the patient who experiences the same kind of pain as before surgery.

On rare occasions, especially in-patients with atypical angina symptoms, the patient may have an unrecognized lung, gastroesophageal or psychosomatic disorder. A few weeks post surgery, some patients present post-cardiotomy syndrome (Dressler's Syndrome) manifested by pleuretic chest pain (pain with deep breathing), fever, fatigue and pleural and/or pericardial rub on auscultation. This inflammatory process resolves spontaneously within a few weeks in most patients. On occasions, they may require antiflammatory drugs to relieve their symptoms.

The most difficult situation is when a patient has chronic sternal pain and all other conditions have been ruled out. In my practice, I have a patient that I have been following for the past 2 years for continuous sternaI pain post coronary artery bypass surgery. He has been taking pain killers (codeine) regularly without great relief. Local anesthesia (tested of the sternal skin did not help much. The pain clinic was unsuccessful (biofeedback) in controlling the pain, and suggested long term pain killer intake. A CAT scan of the chest and gallium scans when repeated were negative. Removal of the sternal wires did not help. the only option left, if the patient cannot tolerate the pain, might be removal of the sternum! I am not too keen in doing so......


Kmpf51
New Member


Date Joined Feb 2013
Total Posts : 1
   Posted 2/4/2013 4:19 AM (GMT -7)   
I had the same problem. Sternum was unstable and separated. Had 2 surgeries to remove pins and then had 5 plates put in about 8 months ago. Sternum does not move however still have a lot of pain in chest and breasts are swollen. I am under care of pain management, cardiologist and still no relief of pain. I heard this could take 5 to 7 years to heal completely. mad

jdiane
Veteran Member


Date Joined Jan 2003
Total Posts : 1074
   Posted 2/4/2013 9:15 AM (GMT -7)   
OMG. I just wanted to say how sorry I am that both of you have this. I can't even imagine how terrible that must be. I had open heart surgery on May and have completely healed and just can't imagine that happening. Yikes!

nige27
New Member


Date Joined Mar 2014
Total Posts : 2
   Posted 3/23/2014 4:56 AM (GMT -7)   
Kmpf51 said...
I had the same problem. Sternum was unstable and separated. Had 2 surgeries to remove pins and then had 5 plates put in about 8 months ago. Sternum does not move however still have a lot of pain in chest and breasts are swollen. I am under care of pain management, cardiologist and still no relief of pain. I heard this could take 5 to 7 years to heal completely. mad
hi mate i had the same things happen to me ,but i,ve only five plates and 20 screws 8 months ago .still in a lot of pain and lots of painkillers .makes you wonder is it ever end,is seems like i can,t do anything without pain .and the funny thing is doctors and surgeons said out of pain six weeks why do they say this when they don't really know .i went back to have an e-ray and then to see my surgeon .only to be told its fine but its going to take time and very small steps .i live on my own so as soon as i left hospital that was it and get on with it ,no help marvellous,happy days all the best Nigel

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   Posted 3/23/2014 8:40 AM (GMT -7)   
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nige27
New Member


Date Joined Mar 2014
Total Posts : 2
   Posted 3/25/2014 7:54 AM (GMT -7)   
my name is Nigel Rawdon Forster i had open heart surgery in April 2011 the wires broke .My doctor did not pick up on this even when I told him that my sternum had come undone .14 month later I went for a x-ray that pick up that something was not right!!! In June of 2013 I had plates put in holding the sternum together .three plates 20 screws and a lot of pain .I was told I would be out of pain in six weeks ,how do they know this when they have not had this operation done to them,when after 8 mouth have gone by still in a lot of pain .To be told by the surgeon that it will be little steps before it gets better.Then why was I not told this in the first place .I'm on a lot of painkillers ,and get very tired,and feel my life will never be the same I've been a carpenter all my life I think I,ll never do this again as the pain is to much well there you have it .the end

Viper1
New Member


Date Joined Sep 2014
Total Posts : 1
   Posted 9/12/2014 2:59 PM (GMT -7)   
Hello, I too am plagued with a post bypass sternal non-union. I had my bypass surgery in December of 2013. And at first my chest was solid. Then by the end of January beginning of February 2014 I started to notice that it was clicking and popping with the pain becoming worse and worse. I also noticed that right between my pec muscles there was swelling and bruising that got darker and larger as the day went on. My surgeon just kept assuring me that everything was going well and it was nothing to worry about.
My cardiologist however, knew better. They scheduled me for a CT scan which was later denied by my insurance due to my surgeons opinion that nothing was wrong. So my cardiologist admitted me to the hospital where they were able to do the CT scan which showed that 4 of the 6 stainless steel wires had snapped and the other 2 had pulled through the bone.
Therefore in March I had my second surgery where they removed the wires and replaced them with titanium plates.
After the second surgery things were better again my chest was fairly solid and healing well I thought until may when I started to notice that it was popping and clicking again. My surgeon again told me it was normal and it would go away.
Well it didn't and in fact it has gotten worse and worse and more and more painful. Now not only does my chest hurt but I have huge sharp shooting pains underneath my pecs where the surgeon, I assume, attached the pec "flaps" and with my chest spreading further and further apart it's pulling those muscles away from their attachment points.
Recently my cardiologist tried again to get me in for a CT scan which was again denied by my insurance but they did approve a more costly and less definitive MRI test.
The MRI showed an ill defined fluid pocket developing again between my pecs and a sternal dehiscence ( a medical term for separation) so I was sent back to my surgeon...again.
This time I thought that armed with the MRI results there was no way he could tell me I was OK and that it was normal. Well he did. He told me that I was going to be OK and it was normal. Sooo after some heated words and him going off on my wife we of course switched doctors.

So present day, changed hospitals, changed surgeons and had all my records transferred. The new surgeon is trying to get me scheduled for another CT scan (good luck to him on that one) based on the results of the mri. He doesn't think another surgery will help if the first two didn't work there's little chance that a third would change anything. I'm only 46 years old and a lifetime of narcotic painkillers really isn't acceptable. He's referring me to a pain clinic anyway just to see if they can help. Outside of that there's really only 2 options left for me he said. Either I learn to live with it the way it is, like someone with TMJ or I have my sternum removed completely.
At only 46 years of age neither option seems to be good. Every breath or movement is pain, every cough or sneeze leaves me on thon.edge of blacking out. I'm looking for a miracle but don't see it yet...
I'll update more as my saga goes on.
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