Tension band cable for sternal nonunion near the manubriosternal joint: a case report

Sternal nonunion is a rare complication of sternal fracture or sternotomy, for which plate fixation with bone grafting is the most common surgical procedure. However, rigid fixation is often challenging for sternal nonunions near the manubriosternal joint owing to the difficulty of inserting sufficient screws into small proximal fragments. Here, a case of sternal nonunion near the manubriosternal joint treated with tension-band cable fixation and iliac bone grafting was reported. A 69-year-old man with a history of sternal fracture sustained in a traffic accident 1.5 years prior presented to the hospital with persistent chest pain. Computed tomography revealed sternal nonunion with a small fragment near the manubriosternal joint. His symptoms interfered with daily activities, necessitating surgery. After nonunion release, cancellous bone grafts were harvested from the iliac crest. Two pins were inserted into the intramedullary canal from the proximal end of the sternal body. The cable was subsequently passed through the sleeves of the pins and a transversely drilled hole in the sternal body and tightened to compress the nonunion site. The chest pain subsided, and bone union was achieved 1 year postoperatively. Tension-band fixation with bone grafting may be a viable option, particularly for sternal nonunions with small fracture fragments. Cite this article as: Furuhata R, Fumoto M, Matsumura N, Tanji A. Tension band cable for sternal nonunion near the manubriosternal joint: A case report. Acta Orthop Traumatol Turc., 2026; 60(3), 0759, doi: 10.5152/j.aott.2026.25759.