Adult Sterna Research Articles

Correlation between various Measurements of Sternum with Stature - An Autopsy based Study

The sternum is of crucial significance while estimating body stature. Dwight, in the late 19th century, discussed potential use of the sternum for estimation of the stature. Various researchers have shown that the sternum may be of use in stature assessment merely when long bones are not obtainable. The study was conducted to analyse the correlation between the stature and various measurements of the sternum. The posterior curved length, length of manubrium, length of mesosternum and length of sternum were measured in 300 adult sterna. The mean length of a cadaver (Stature) was observed to be greater in males (162.34 ± 8.03 cm) as compared to females (156.53 ± 8.50 cm). A positive moderate correlation (R ranging from 0.332 to 0.647) was observed between various measurements of sternum with stature in both the genders. Sternal length shall be considered as a better parameter over other sternal measurements for estimating the stature. However the application for utilizing the sternum for stature estimation should be restricted to the population sample for and from which they have been developed.

A Morphometric Study of Adult Human Sterna from the Galloway Osteological Collection

Background: Morphometric knowledge of the sternum is of great significance in cardiac surgery as variations in sternal dimensions have been considered a risk factor for translocation of suture material during median sternotomy, leading to poor outcomes. Fatalities attributed to subnor- mal sternal thickness have also been reported during sternal biopsies. Fractures of the sternum secondary to chest injury or cardio-pulmonary resuscitation may also be influenced by sternal thickness. Elongated xiphoid process can be mistaken for an epigastric mass which can be painful on palpation. Morphometric studies of African sterna are rare. The objective is to the study sought to describe the morphometry of adult sterna from the Galloway bone collection, Makerere University, Kampala, Uganda. Subjects and Methods: This study employed a descriptive cross sectional design to collect and analyze quantitative data. Eighty five dry adult sterna (75 males and 10 females) were examined at the Department of Human Anatomy, Makerere University. Data analysis at univariate and bivariate levels were performed using SPSS version 21.0 statistical software. Results:A significant difference in the average length of the mesosternum was found between males at 94.6 mm (SD 11.2) and females at 82.2 mm (SD 15.2) (P=0.002). Two cases (9.5%) presented with elongated xiphoid process and one (1.2%) with subnormal mesosternal thickness. Conclusions: Our study highlights the importance of knowledge of the sternal morphometry in sex identification, physical examination, sternal puncture and other thoracic procedures, calling for increased awareness of the findings.

Determination of Sex from Human Adult Sternum

Background: Forensic Medicine is a growing medical field with many subareas. General public usually associate the subject with the dead and autopsies alone. Forensic Anthropology is the sub field in physical anthropology, especially for solving criminal cases by applying skeletal analysis. The present study was done to study, compare, analyze the sternal measurements among both sexes and evaluate the reliability of different parameters of the adult sternum to determine the sex of an individual.Materials and Methods: Present study was a prospective study done at Department of Forensic Medicine at Kasturba Medical College, Manipal during the period of 2015-2018 on 92 dead individuals belonging to the South India, whose age was more than 18 years. The study population comprised of 47 males and 45 females and statistical analysis was done. The following measurements were obtained, M1-Length of manubrium; M2 Length of mesosternum; M1+M2-Combined lengths of manubrium and mesosternum; MCI-Manubrio corpus index; W4 Width of the sternum at the level of the fourth rib.Results and Conclusion: All the parameters were observed to be statistically highly significant with a p<0.001. This study reinforces that sexing of human sternum is possible with reasonable accuracy with combinations of new parameters

Determination of sex From the Human Adult sternum: An Autopsy Based study

Determination of sex from the skeletal remains is of immense importance in the field of forensic medicine. Various anthropometric studies conducted in this part of the globe have demonstrated sternum as an important tool for determination of sex when less specific/sex indicative bones are available. This study aims to study, compare and analyze the sterna measurements among both sexes and evaluate the reliability of different parameters to determine sex from an adult sternum. 120 sterna (65 male and 55 female) were collected from the autopsy. After cleaning and drying for three weeks, three readings each were taken and the averages of the results were recorded in millimeters. Metric data was summarized as mean, standard deviations and percentage proportions. Among the five parameters used it was proven that the width of the sternum at the level of 4th rib was the most reliable parameter in determining the sex. The application of Hyrtl's law to the study proved that 40% of male sterna and 98.18% of female sterna obeyed it. The application of Ashley's rule of 149 and 136 revealed that 81.66% of male sterna and 90% of female sterna could be sexed accurately.

A study of sexual dimorphism in human sterna

In the present study, 100 human, dry adult sterna, 45 male and 55 female, from various medical colleges of Saurashtra region of Gujarat were measured for length of manubrium, length of mesosternum and combined length of manubrium and mesosternum. The data was statistically analysed for mean, standard deviation and p value. “The Rule of 136” given by Ashley (1956) was applied to determine the sex of sterna and to determine the number of male and female sterna obeying the rule. Statistically significant difference in mean values of length of manubrium, length of mesosternum and combined length of both sexes was observed. “Rule of 136” determined 34 male and 66 female sterna, while 71.11% (32) of male sterna and 96.34% (53) of female sterna obeyed the rule. It concluded that of all the three parameters measured, combined length of manubrium and mesosternum was the best discriminating parameter of sex and Rule of 136 was helpful in determination of sex.

Prevalence of Abnormal Sternal Angles in a Kenyan Population

Abnormal sternal angles are unique anatomical variations of major clinical significance. For instance, misplaced sternal angles may cause inaccurate numbering of ribs and thus complicate intercostal nerve blocks and needle thoracostomies. They are also associated with increased risk of sternal fracture in blunt chest trauma. Additional sternal symphyses can be misinterpreted as fracture or lytic lesion in cross-sectional imaging of the sternum. These variations are rarely reported in Africans and lacking in the Kenyan population. We therefore aimed to determine the prevalence of abnormal sternal angles in a Kenyan population. 80 cadaveric adult sterna were studied at the Department of Anatomy, University of Nairobi, after ethical approval. The size of the angle was measured using a sliding protractor (CCKL, U.K). Results were analyzed by SPSS 18.0. The sternal angle was located at the level of the third costal notch in 7 cases (8.8%). It was un-ridged in 8 cases (10%). The angle measured 161.7° ± 4.7 in males and 159.9° ± 4.9 in females (p=0.165). In 9 cases (11.25%), the angle measured less than 150°. An additional sternal symphysis was present in 6 specimens (7.5%). Over 35% of sternal angles in Kenyans showed an abnormality in location, palpability or size. These variations may influence intercostal nerve blocks, interpretation of sternal images and evaluation of chest trauma. Further research is needed to correlate these findings.

Cadaver Testing to Validate Design Criteria of an Adult Intraosseous Infusion System

The FAST 1 intraosseous (IO) infusion system was designed to deliver fluids and medications into the adult sternum in the prehospital and battlefield environments. To test the prototype in 106 cadavers and excised sterna and compare it with other IO devices. The insertion force was similar to that of other IO devices (mean, 8.5 kg; range, 2.3-19.6 kg). In 39 of 39 trials, the depth-control mechanism inserted the portal within 1.0 mm of a predetermined distance below the anterior surface of the cortical bone. If misplaced, underpenetration was more likely than overpenetration (mean displacement, -0.3 mm; SD, 0.5 mm). After release, the portal could not be advanced further into the manubrium. Marrow was accessed in 75 of 77 trials. Mean flow rates were 109 mL/min for normal saline solution and 102 mL/min for hypertonic saline/dextran, similar to the Cook Sur-Fast device. The cadaver and bench tests demonstrated the reliability and safety of the FAST 1 system at the design/prototype stage.

Aortic Valve Replacement By Mini-Sternotomy

The introduction of the laparoscopic procedure, as well as later scope-based interventions by other surgical disciplines have resulted in the development of minimally invasive cardiac surgical procedures. These incisions are often foreign to traditional cardiac surgeons, but are now being increasingly used to approach aortic and/or mitral valves. Although important contributions in these areas continue to accrue almost daily, our group became convinced several years ago that access to the heart could be achieved by a modification of the traditional sternotomy, incorporating traditional cannulation techniques with a more limited exposure of the heart. Beginning in January 1996, we began performing pediatric heart operations through a partial division of the sternum, ie, only a portion of the sternum was divided in the midline. Owing to the flexibility of children’s tissues, the partially divided sternum could be stretched open with a retractor. In March 1996, we began performing aortic and mitral valve operations in adults through a similar upper sternal division. The rationale for this approach is simple: both the aortic and mitral valves are midline structures and both lie in a plane than can be best viewed obliquely from above the right shoulder. Furthermore, upper sternal division brings the surgeon directly down to the aorta and the right atrial appendage for cannulation of these traditional structures for venous return and arterial inflow. However, unlike children, the inflexible adult sternum was “T-ed” off at the second, third, o r fourth intercostal space in addition to dividing it in the midline. Although many terms can be used to describe these sternal divisions and many variations of the inverted T now exist (ie, the J, the reverse J, the L, the S, and the C, and many terms for this partial sternal division can now be found in the literature, such as hemisternotomy, partial sternotomy, limited sternotomy, and more), we coined the term mini-sternotomy (1994) to describe coronary artery bypass off-pump.” We have now had the opportunity to apply this technique to over 250 patients, but this report will limit itself to the first 110 patients who have had aortic valve procedures by mini-sternotomy. ( 6

Supra-sternal ossicles in primates other than man.

DR. G. T. ASHLEY'S communication1 prompts me to record a further example of supra-sternal ossicles in primates, this time in Perodicticus potto. The specimen, which was the prepared skeleton of a young animal, showed a supra-sternal ossicle on the right side only, contributing to the articular surface for the clavicle (Fig. 1). The ossicle on the left side was presumably lost during preparation. From a comparison with the adult sternum, it would appear, that in Perodicticus the supra-sternal ossicles are responsible for the prominent antero-lateral angles of the manubrium sterni and thus for the deep supra-sternal notch. It is possible that they are a regular feature in the development of the sternum in this animal. It must not be forgotten, however, that the supra-sternal notch in man is considerably shallower in the newborn than in the adult, though supra-sternal ossicles do not seem to be a constant feature here.