Sternal Body Research Articles

Analysis of clinical characteristics and image for sternum tumor

To analyze the clinical characteristics and imaging features of sternum tumor, in order to improve the knowledge of the diseases. The clinical data and imaging data of 18 patients with sternum tumor were retrospectively analyzed. There were 13 males and 5 females, aged from 24 to 73 years old with an average of 58.3 years. Eleven patients were treated by conservative treatment and 7 patients were treated by surgery. The course of disease ranged from 2 months to 6 years. One patient had no obvious symptoms and 1 patient had a history of chest trauma. Lesion location, pattern of bone destruction, cortical bone abnormality, MRI signal characteristics and contrast enhancement were observed in the patients. Eighteen cases included malignant bone tumor in 16 cases and benign tumor in 2 cases;and 7 cases located in sternal manubrium, 9 cases located in sternal body, and 2 cases located in both. On the imaging, sternal tumor had expansively developing tendency, and the bone destruction zone boundary continuity or partial disruption occurred in 15 cases, the border of cortical bone thinning in 2 cases, the cortical bone increased thickness in 1 case. No bone marrow edema around tumor was found in 7 cases by MRI and soft tissues was encroached in 2 cases; in T1WI of MRI, 4 cases showed the hypointense signal and 3 cases showed the iso or hyper intensity signal; in T2WI of MRI, 6 cases showed the iso or hyper intensity signal and 1 case showed confounding signal. Enhancement scanning in MRI, premodinantly tumors showed obviously strengthening. The types of the sternum tumors are various and the most tumors are malignant. The images of the mostly sternum tumor absented same charactiristic, and it must combine with clinical manifestation to analyze the X rays, CT scanning and MRI, it will conduce to improve the diagonstic accuracy of the sternum tumors.

Measurement of sternal curvature angle on patients with pectus excavatum.

Pectus excavatum (PE) is a chest deformity characterized by marked sternal depression. The objective of this study was to quantify the sternal curvature observed in patients diagnosed with PE using the sternal curvature angle (SCA). A retrospective review of lateral chest X-rays of patients with PE from 2006 to 2013 was performed. The SCA was measured in a manner similar to the method of Cobb's angle is used to measure spinal curvature. SCA and Haller index were calculated from the chest X-rays for all patients. Lateral chest X-rays of 202 PE and 196 normal control patients were analyzed. The mean SCA±SD of PE patients was 40.56°±12.88° compared to 22.02°±7.65° for normal patients. The difference was statistically significant with a p value of <0.0001. No significant concordance between SCA and Haller index measurements in the PE group was found (Kendall τ=-0.00015, p value=0.9975). The difference in sternal curvature as measured by the sternal curvature angle between the pectus excavatum and normal patients was statistically significant. Our data suggest that sternal depression evident in PE patients is not a simple linear depression of the sternum but due to curvature in the sternal body.

The safe zone for blinded sternal interventions based on CT evaluation of midline congenital sternal foramina

The aim of this study was to evaluate the safe zone for performing blind sternal procedures based on computed tomography (CT) evaluation of congenital midline sternal foramina using multidetector computed tomography (MDCT). This retrospective study was carried out on 1,180 patients who underwent MDCT of the thorax from March 2015 to February 2016. The MDCT images were evaluated in axial and reformatted planes. Morphometry and prevalence of midline congenital sternal foramina (SF) and manubrio-foraminal distance (MFD) were evaluated. The safe zone was defined for a blinded intervention, based on palpable anatomical landmarks. Data were presented in terms of percentage, mean±standard deviation and calculations were carried out using Microsoft Excel. The prevalence of SF in our study sample was 11.6%. The majority of SF were located in a typical position in the lower sternal body at the level of fifth costo-chondral junction (CCJ) in 108 patients (78.8%). The structure directly beneath the SF was mediastinal fat in 73 patients (53.3%), followed by anterior pericardium in 44 patients (32.1%) and lung parenchyma in 20 patients (14.6%). The mean MFD in our study population was 11.90 ± 1.31cm. Sternal interventions should be avoided at the level of fourth to sixth CCJ, which is considered the danger zone. An intervention at the fourth to sixth CCJ may lead to disastrous consequences in patients who have SF.

Nuss procedure for surgical stabilization of flail chest with horizontal sternal body fracture and multiple bilateral rib fractures

Flail chest is a life-threatening situation that paradoxical movement of the thoracic cage was caused by multiply fractured ribs in two different planes, or a sternal fracture, or a combination of the two. The methods to achieve stability of the chest wall are controversy between surgical fixation and mechanical ventilation. We report a case of a 33-year-old man who fell from a high place with fail chest due to multiple rib fractures bilaterally and horizontal sternal fracture. The conventional surgical stabilization using metal plates by access to the front of the sternum could not provide stability of the flail segment because the fracture surface was obliquely upward and there were multiple bilateral rib fractures adjacent the sternum. The Nuss procedure was performed for supporting the flail segment from the back. Flail chest was resolved immediately after the surgery. The patient was weaned from the mechanical ventilation on third postoperative day successfully and was ultimately discharged without any complications.

Solitary bone and brain metastasis in a patient with papillary thyroid carcinoma mimicking cavernous angioma

Solitary bone and brain metastasis in a patient with papillary thyroid carcinoma mimicking cavernous angioma

A clinical decision-making model for repeat surgical treatment of pectus Bar displacement: distance measurement after nuss procedure.

BackgroundBar displacement is one of the most common and serious complications after the Nuss procedure. However, measurements of and factors affecting bar displacement have not been reported. The objectives of this study were to develop a decision model to guide surgeons considering repeat treatment and to estimate optimal cut-off values to determine whether reoperation to correct bar displacement is warranted.MethodsFrom July 2011 to August 2013, ninety bars were inserted in 61 patients who underwent Nuss procedures for pectus excavatum. Group A did not need surgical intervention and Group B required reoperation for bar displacement. Bar position was measured as the distance from the posterior superior end of the sternal body to the upper border of the metal bar on lateral chest radiographs. The bar displacement index (BDI) was calculated using D0 - Dx / D0 x 100 (D0: bar position the day after surgery; Dx: minimal or maximal distance of bar position on the following postoperative days). The optimal cut-off values of BDI warranting reoperation were assessed on the basis of ROC curve analysis.ResultsOf the 61 patients, 32 had single bars inserted whereas 29 had parallel bars inserted. There was a significant difference in age (14.0 ± 7.5 vs. 23.3 ± 12.0, p = 0.0062), preoperative Haller index (HI) (4.0 ± 1.1 vs. 5.0 ± 1.0, p = 0.033), and postoperative HI (2.7 ± 0.4 vs. 3.2 ± 0.5 p = 0.006) between the two groups. The optimal cut-off value of BDI was 8.7.ConclusionsWe developed a BDI model for surgeons considering performing reoperation after Nuss procedure. The optimal cut-off value of BDI was 8.7. This model may help surgeons to decide objectively whether corrective surgery should be performed. The main factors affecting the relationship between bar displacement and reoperation were age and preoperative HI.

Estimation of age from human sternum-an autopsy study

Background & Objectives: Estimation of age in elderly person is often required in medico legal practice. Estimation of age in elderly person is comparatively more difficult than in young persons. The aim of the study was to determine the age of an individual from fusion of various parts of the sternum. Methods: Sterna were obtained from 53 males and 47 females aged between 14 years to 75 years from known corpses during medico-legal autopsies at Tirunelveli Medical College, Tamilnadu, India by dissection and maceration of soft tissues. Results: When the segments of the body of sternum are fused, the age of an individual should be above 21 years. If the manubrium and body of sternum is not fused, the age of the Individual is less than 35 years in males and less than 43 years in females. If the xiphoid process and body of sternum is fused, the age of the individual is more than 32 years in males and more than 40 years in females. Interpretation: Age estimation from union of manubrium and xiphoid with the body of the sternum seem to be reliable where the sex is already determined. Fusion of segments of body of sternum is a more reliable in estimation of age of an individual irrespective of the sex. Conclusions: This study proves that sternum is a reliable tool to estimate the age of a person. Key words: Sternum, Fusion, Age, Identification

Is Human Sternum a Tool for Determination of Sex?

Background & objectives: Determination of sex is a vital part of medico-legal practice. The objective of the study was to obtain cut off values for determination of sex by measuring the length and breadth of manubrium and body of sternum. Methods: Through dissection and maceration of soft tissues, 103 sterna (53male and 50female) between 15 years to 75 years were obtained from known corpses during medico-legal autopsies at Tirunelveli Medical College, Tamilnadu, India. Results: This study revealed that it could be a male if the length of body of sternum is greater than 87mm, length of manubrium is greater than 50mm, breadth of body of sternum is greater than 38 mm, breadth of manubrium is greater than 60mm, combined length of manubrium and body of sternum is more than 136mm and sternal index is 47 or below whereas it could be of female if the length of body of sternum is less than 72 mm, breadth of manubrium is less than 48 mm, breadth of body of sternum is below 29 mm, combined length of manubrium and body of sternum is below 119 mm and sternal index is 70 or above. Interpretation: Higher percentage of accuracy is found with length of body of the sternum, combined length of manubrium and body of sternum in both sexes, whereas they are more reliable in males. Conclusions: This study proves that the sternum is a reliable bone to determine the sex of a person. Key words: Body of sternum, Identification, Manubrium, Sex

A study on medico-legal and clinical aspects of congenital sternal foramina

Sternal foramen is a congenital round bony defect present in the body of sternum which results from incomplete union of the sternal ossification centres. Usually the defect is asymptomatic and only be detected by CT scan. But at times, it may be misinterpreted as gun shot or stab wound. In clinical practice, sudden unexpected death may take place during sternal puncture and biopsy as a result of cardiac puncture and tamponade. The present study was carried out by choosing 96 dry sternal bones which were used as a teaching material in the Department of Forensic medicine and Anatomy, CCM Medical College, Durg, Chhattisgarh and MIMER Medical College, Talegaon, Pune, Maharashtra. These sternal bones were examined for the presence of sternal foramen and it was found in 4.1% of cases. It is important for medical practitioners, radiologists and acupunturists to have a concrete knowledge of sternal anomalies before doing any procedures to avoid complications.

A Study of Sternum as an Indicator of Sex

Establishing the identity of a dead body is a crucial and exacting process for a Forensic pathologist especially when the body is mutilated, decomposed or skeletonised. Since bones exhibit morphological differences with respect to sex, various bones including the sternum have been used for sex determination. This being the objective of the study, 153 sternum from autopsy specimens were collected and studied utilizing various measurements of the bone which were then statistically analysed. Length and breadth of the manubrium and body of sternum, its total length and sternal index were the parameters studied based on which sexing was carried out. All the measurements except the sternal index, quite significantly were found to be more in males compared to females. Certain values for these parameters were obtained from this study, which could be suitably used for determination of sex in situations like those mentioned above.

Sexual dimorphism of sternum using computed tomography – volume rendering technique images of Western Chinese

Previous studies have revealed that the sternum can provide a method for assessing sex in diverse population groups. In the current study, sternal measurements were recorded from three-dimensional multidetector-computed tomographic images of 255 individuals (112 females and 143 males) in Western China. Results demonstrated that the difference between male and female mean values for all linear dimensions and manubrium index was highly significant. The stepwise analysis of four linear sterna dimensions and manubrium index, in which the sternum index, total length and manubrium width were selected, yielded a sex classification accuracy rate of 81.6% and a sex bias of 2.6%. Furthermore, multivariate discriminant function equations incorporating dimensions of the manubrium and individual sternal dimensions, such as the total length of the sternum and the sternum body, may also be of value in the estimation of sex. The results of the present study with osteometric equations provide an effective method for assessing sex in Western Chinese, particularly in situations where the pelvis or bones of the extremities are not preserved, and the CT-VRT may be a practical method for estimation of sexual dimorphism.

The oblique fracture of the manubrium sterni caused by a seatbelt--a rare injury? Treatment options based on the experiences gained in a level I trauma centre.

Sternal fractures are rare with 3-8 % out of the total number of trauma cases mostly caused by direct impact to the anterior chest wall. Most cases described are due to motor vehicle crash either caused by direct impact to the steering wheel or by the seat belt. Fractures mainly occur to the sternal body. Only rarely are cases of manubrium fractures described in literature, for example, in relationship with a direct impact to the shoulder which caused an oblique fracture near to the sternoclavicular joint. Three patients with profoundly dislocated oblique manubrium fracture were admitted to our Level I Trauma Center in 2012 and 2013. Those patients suffered from instability of the upper sternum and the shoulder girdle. Between January 2012 and October 2013, a total of 538 trauma patients were admitted to the emergency room and received whole body CT-scan. They were analysed retrospectively for sternal fractures. In cases of instability and dislocation, fracture stabilisation was performed by anterior plating through a medial approach using low profile titanium plates (MatrixRib®). Seventy-nine (14.7 %) patients showed sternal fracture, out of which 13 (2.4 %) patients showed a fracture of manubrium, ten caused by seatbelt. In three cases stabilization was performed. Follow up showed sufficient consolidation without complications. A total of 16.5 % of sternal fractures were localized at the manubrium, mostly caused by seat belt. Fractures without significant dislocation seemed to be stable and healed well under conservative treatment. Dislocation in this region leads to unstable shoulder girdle. Anterior plating provides sufficient stabilisation and allowed consolidation.

Sternal Tumor Resection and Reconstruction with Titanium Mesh: a Preliminary Study

To explore the clinical efficacy and complications of treating sternal tumors by resection and titanium mesh thoracic reconstruction. This retrospective analysis of eight patients with sternal tumors treated in the Department of Orthopedic Surgery at the First Affiliated Hospital of Zhengzhou University from January 2008 to June 2012 included five men and three women aged 37-66 years (mean, 50.4 years). The histological diagnoses were chondrosarcoma (two cases), osteosarcoma (one), malignant fibrous histiocytoma (two), eosinophilic granuloma (one) and sternal metastasis from breast cancer (two). The tumors were invading the manubrium sterni (three cases), manubrium sterni and body (three) and sternal body (two). All patients underwent needle or incisional biopsy prior to sternal tumor resection and titanium mesh thoracic reconstruction. All patients were followed for 9 months to 4 years. There were no intraoperative complications or operative or postoperative deaths. One patient developed a deep wound hematoma 1 week postoperatively; incisional drainage and debridement resulting in healing within 2 weeks. There was no loosening or exsertion of the titanium mesh and no patients developed respiratory complications or thoracic deformity. One patient with malignant fibrous histiocytoma died of lung metastases 9 months postoperatively, another with malignant fibrous histiocytoma died of liver metastases 14 months postoperatively; the remaining patients survived without tumor recurrence. Titanium mesh chest reconstruction after sternal tumor resection has the advantages of simplifying the procedure, achieving a good shape and having few complications. Titanium mesh is an ideal material for reconstruction of the sternum.

Head partitions at the feed barrier affect behaviour of goats

Space allowance at the feeding places often forces goats to feed in close proximity, that is, less than their individual distances. In consequence, agonistic behaviour may increase as well as stress and injuries, while access to feed may decrease, especially in low-ranking goats. Partitions between single feeding places may reduce individual distances and may enhance the acceptance of goats feeding close by. The aim of this study was to investigate the influence of non-transparent head partitions at the feed barrier on agonistic behaviour, activity budget, feeding place occupancy, adrenocortical activity, nutritional status (body weight and body condition), and injuries in loose-housed dairy goats.The study involved 72 pregnant dairy goats of the German Improved Fawn breed. Two groups of 36 animals each were tested in a cross-over design. At the beginning, one group was provided with head partitions at a wooden palisade feed barrier, whereas the other group stayed without head partitions. After 11 experimental days, the head partitions were switched to the other group. Social interactions were recorded for 13h and 20min per treatment (2h and 40min on 5 days each group). Activity budget and feeding place occupancy were observed via scan sampling for 48h per treatment. Body weight, body condition score, and occurrence of injuries were assessed, and faeces were sampled for analysis of cortisol metabolites. Data were analysed by Wilcoxon-tests for dependent data, except for feeding place occupancy, where t-tests were used. Goats displayed less agonistic behaviour in the feeding area with head partitions at the feed barrier (p=0.003). In addition, with head partitions a lower number of displacements from feeding place by an actor standing inside the feed barrier was found (p=0.002). The impact was most pronounced in low-ranking animals (p=0.009), but effects were also found in middle-ranking goats (p=0.030). Low-ranking goats were observed less often feeding (p=0.009) and more often lying (p=0.026) during the first hour after feed supply with head partitions. With head partitions more goats were feeding directly next to each other, i.e. without an empty feeding place in between (p=0.017). Regarding the nutritional status of the goats, the lumbar body condition scores were higher in high-ranking animals with head partitions (p=0.007). Presence of head partitions had no effect on sternal body condition scores, body weight, concentrations of faecal cortisol metabolites, and occurrence of injuries. In summary, non-transparent head partitions seemed to reduce the accepted distance between goats and therefore showed beneficial effects in terms of lower levels of social disturbances during feeding. Thus, head partitions can be recommended for feed barriers in goat loose-housing systems.

Staging and Response of Sternal Histoplasmosis by 18F-FDG PET/CT

Histoplasmosis, a granulomatous mycosis caused by the fungus Histoplasma capsulatum, is known to primarily affect the lungs and the immune system, with involvement of skeletal system as a rare manifestation, in which case the disease usually assumes multifocality. We present a singular case of a young man diagnosed to have an isolated skeletal histoplasmosis involving the body of sternum where 18F-FDG PET/CT played major role in both diagnosis and in response evaluation to antifungal therapy.

A rare case of sternal bony metastasis in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common malignancies of the world and about 30-50% cases of HCC have extra hepatic metastases. 1 Bone is considered to be an uncommon site for metastasis in HCC. We report a case of HCC with secondaries in the body of sternum. Review of literature also shows that bone is not that uncommon site for metastases in HCC and HCC should be considered in the differential diagnosis of patients with bony metastases.

Multiple chest wall swellings in adult Burkitt's lymphoma

A 64-year-old male farmer presented to our hospital in April, 2013, with a 3 month history of painless, progressive swelling of his chest wall and lower jaw, and 10 kg unintentional weight loss. On examination he had multiple lumps about 3 × 1⋅5 cm around the angle of the mandible, and multiple 10 × 8 cm lumps at the mid sternal region and of the left lower anterior chest wall (fi gure). These lumps were non-tender to palpation, hard, and tethered, with irregular contours, no tempertature changes or overlying skin changes. Blood tests were normal and HIV serology was negative. CT Chest showed a soft tissue mass 8 × 10⋅6 × 8 cm encasing and eroding the body of sternum with presternal and retrosternal soft tissue components (appendix), and whole-body PET CT fusion showed increased 18F-fl uorodeoxyglucose (18F-FDG) uptake (appendix). Histological and immunohistochemical examination of a biopsy specimen from the chest wall swelling showed tightly-packed small round cells with high mitotic activity infi ltrating fat and starry sky appearance (fi gure), positive for CD20, Bcl-2, Mum-1, and Bcl-6, and negative for CD10, CD3, Cyclin-D1, and TdT, with Ki-67 nearly 100%. Conventional cytogenetics showed complex structural and numerical abnormalities including characteristic t (8;14) (appendix). We diagnosed high risk group adult Burkitt lymphoma stage IV, and started treatment with modifi ed Magrath regimen of four alternating cycles of R-CODOX-M and R-IMVAC chemotherapy. The patient achieved complete remission with disappearance of sternal swellings, normal peripheral blood counts, normal bone marrow aspirate, and no evidence of 18FDG uptake on repeat PET scan. He remained in remission at last 3 month follow-up in December, 2013. Lancet 2014; 384: 2244

Determination of Sex From Sternal Dimensions in Upper Egypt Population By Using Multislice Computed Axial Tomography

Sex determination is an important step in personal identification which can be done from bones examination either from their metric measurements or radiograph images especially in difficult identification as dismemberments, mutilations and explosions. The present study was designed to assess the possibility of sex determination from sternal measurements by multislice computed axial tomography (MSCT) and generate statistical equations that can be used to determine sex from sternum in Upper Egypt persons. This study was performed on one hundred and sixty healthy living Upper Egypt persons (80 males and 80 females) of age 18-80 years old during MSCT investigation of the chest region, in department of radiodiagnosis in Assiut University hospital after informed consent. Fourteen sternal measurements were taken including manubrium length, sternal body length, combined length of the manubrium and sternal body, sternal index, manubrium width at tip, width and base, sternal body width at articulation with 2nd, 3rd, 4th, 5th and 6th ribs and two virtual angles of sternum. First angle lies between two intersected virtual lines made along the lateral aspect of the upper part of the sternal body and the lateral aspect of the manubrium. Second angle lies between two virtual lines drawn along the lateral margins of the lower part of sternal body and xiphoid process. The data were analyzed statistically. Results of this study demonstrated that the male measurements showed higher statistical significant values than females measurements except sternal index. Use of the multiple and simple regression equations of relation between sternal measurements and sex demonstrated that the total body length was the most significant parameter for sex prediction. The discriminant function analysis revealed correct sex prediction in known Upper Egyptians by 93%. The multivariant logistic regression can give correct sex prediction in unknown Upper Egyptians by 85.4%. This study concluded that sex determination can be done through sternal measurements including the virtual sternal angles, the MSCT is a trustful method for bone measurement during forensic investigation and sex prediction from measurements of all sternal parts is higher than those from single part.

Sexual dimorphism of human sternum in a contemporary spanish population

Sex estimation is one of the first steps in forensic anthropology to identify human remains. In absence of the skull or the pelvis, any skeletal remain becomes fundamental for identification, especially in mass-disaster cases. The sternum is a potentially useful element in anthropological analysis with a high recovery rate in both forensic-and archaeological context. This study aims to develop classification functions for use in Spanish population. For this, sternum sexual dimorphism is studied in a sample of 105 individuals, known age-at-death, ancestry and sex, from San José Municipal Cemetery of Granada (Spain). Lin’s concordance correlation coefficient was used to estimate intra-and inter-observer error. In discriminant analysis for estimating sex, cross-validation shows accuracy rates exceeds 90% for sternum body length and maximum width (91.8%), or total length with maximum width (90.7%). Isolated variables with higher accuracy rates are total sternum length (89.1%), and sternum body length (87%). Although there is compliance with Hyrtl’s law it is not useful for estimating sex in Spanish population. These discriminant functions have also been validated successfully in two samples from Portugal (Coimbra identified skeletal collection – CISC, and 21st century identified ckeletal collection – Santarém XXI): the variables with higher accuracy rates sternum total length with its maximum width (92.3% the correctly classified individual in the sample CISC; and 83.5% in the sample of Santarém XXI) and the sternum total length (92.1% and 78.5%, respectively). The discriminant functions achieved with the collection of the San Jose cemetery of Granada can be applied to current remains, provided that study populations present a similar sexual dimorphism, like the two samples from Portuguese population presented in this study.

Morphometric analysis of variation in the sternum with sex and age.

Age and sex-related variations in sternum morphology may affect the thoracic injury tolerance. Male and female sternum size and shape variation was characterized for ages 0-100 from landmarks collected from 330 computed tomography scans. Homologous landmarks were analyzed using Procrustes superimposition to produce age and sex-specific functions of 3D-sternum morphology representing the combined size and shape variation and the isolated shape variation. Significant changes in the combined size and shape variation and isolated shape variation of the sternum were found to occur with age in both sexes. Sternal size increased from birth through age 30 and retained a similar size for ages 30-100. The manubrium expanded laterally from birth through age 30, becoming wider in relation to the sternal body. In infancy, the manubrium was 1.1-1.2 times the width of the sternal body and this width ratio increased to 1.6-1.8 for adults. The manubrium transformed from a circular shape in infancy to an oval shape in early childhood. The distal sternal body became wider in relation to the proximal sternal body from birth through age 30 and retained this characteristic throughout adulthood. The most dramatic changes in sternum morphology occur in childhood and young adulthood when the sternum is undergoing ossification. The lesser degree of ossification in the pediatric sternum may be partly responsible for the prevalence of thoracic organ injuries as opposed to thoracic skeletal injuries in pediatrics. Sternum fractures make up a larger portion of thoracic injury patterns in adults with fully ossified sternums. The lack of substantial size or shape changes in the sternum from age 30-100 suggests that the increased incidence of sternal fracture seen in the elderly may be due to cortical thickness or bone mineral density changes in the sternum as opposed to morphological changes.