With a minimum of 345,000, in the US alone, annually performed surgical procedures that involve splitting the sternum to enter the thoracic cavity and gain access to the heart and other key organs, the need for effective sternal closure poststernotomy is vital. For the last few decades, surgeons have relied on stainless steel wires as their preferred chosen method of sternal closure. Although the reported failure rate of this technique is low (25%), many patients still experience pain, clicking, and other problems associated with nonunions that go untreated. The sternum is a unique bone located in an environment of constant motion. The thoracic cavity is highly vascularized, but a common practice of open-heart procedures is to remove one of the key blood supplies to the sternum for the heart. The bone is mostly cancellous with a very thin cortical shell, and its quality is often compromised, as many heart patients have other serious comorbidities such as:

• Chronic obstructive pulmonary disease (COPD)
• Obesity
• Diabetes
• Previous steroid therapy
• Osteoporosis

Problems with infection and failed closures have to be taken seriously, especially given the proximity to the heart. The need for an improved closure device has been recognized for many years and several products have attempted to solve this problem. For various reasons, none of these products have been able to obtain significant market share from the standard of care. The new Modular Sternal Cable System has been developed to address these needs. It consists of three basic implant components, which can be used alone or in combination, based on the surgeons preference and on patient condition.