Sternal Body Research Articles

The pattern of duck sternal ossification and the changes of histological structure and gene expression therein

As the largest single bone, avian sterna are very different from those of mammals in terms of morphology and functions. Moreover, years of artificial selection in poultry led to incomplete sternal ossification at slaughter age, which may cause diseases, sternal injury, and restriction to breast muscle growth. However, in living birds, studies have rarely described the ossification pattern and underlying mechanisms of the sterna. Here, we examined the pattern (timeline, ossification centers, ossification directions, weekly changes of different parts, quantified differences in ossification degree among sexes and parts) and developmental changes (histological structure, gene expression) of postnatal duck sternal ossification. Direct observation and alcian blue and alizarin red staining of whole sterna samples revealed that, duck sterna mainly ossified during 5 to 9 wk old with five ossification centers. These centers and their ossification directions were different from and more complex than the previously studied birds. The weekly changes of sterna and the quantitative analysis of ossification-related traits showed that ossifications in the three parts of duck sterna (sternum body, keel, posterolateral processes) were mutually independent in space and time, meanwhile, the male duck sterna were more late-maturing than the female. The results of hematoxylin-eosin, alcian blue, and toluidine blue stainings and the expression levels of COL2A1, COL10A1, COL1A2, and CTSK together supported that, duck sternal ossification was highly similar to typical endochondral ossification. Furthermore, continuously high expression of MMP13 and SPARC and their significant (P < 0.05) co-expression with COL2A1, COL10A1, COL1A2, and CTSK suggested the importance of MMP13 and SPARC in duck sternal ossification. Taken together, our results may be helpful for the understanding of avian sternal ossification and the improvement of the performance and welfare of poultry from a new perspective.

Age Estimation from Fusion of Manubrium &amp; Xiphoid Process with Sternal Body: A Radiological Study in Living Individuals from Central India

Forensic Age Estimation is an expertise in Forensic Medicine which aims to find out the most accurate wayof determining the chronological age of the unknown person involved in judicial or legal proceedings. Thisstudy aims to investigate the relationship between the stage of union at Manubrium, Sternum &amp; XiphoidProcess and biological age in Chhattisgarh population. The study was carried out in 270 healthy subjects(135 males and 135 females) aging from 25 to 70 years. The obtained results from the radiographs revealedthat the complete fusion of Xiphoid process &amp; Manubrium with the body of sternum is seen in more than&amp; 70% of individuals in the age group of 50-55 years. Females were consistently developing union at ayounger age than their male counterparts. Results also suggest that the age of union is found to vary greatlyall over the India indicating the need for separate standards of age of epiphyseal union for separate regions.

Traumatic Sternal Fractures can be Safely Treated Conservatively - A 13-Year Retrospective Cohort Study.

Traumatic sternal fractures are rare injuries with little evidence supporting the best treatment strategy. This study assessed treatment outcomes from our level-I trauma centre. A retrospective cohort study was conducted, including all sternal fracture patients admitted to our level-I trauma centre between 2007 and 2019. Patients with sternal fractures due to cardiopulmonary resuscitation, patients <16 years, patients who died during initial hospital stay, and patients lost to follow-up were excluded from analysis. In 13 years, 355 patients with traumatic sternal fractures were admitted, corresponding to 2% of all trauma patients. 262 patients were included in analysis. Mean age was 52 years and 71% of patients were male. Mean ISS was 19 (range 4-66). The majority of sternal fractures was located in the sternal body. Six patients (2%) underwent primary sternal fixation. Treatment failure occurred in three patients (1%) and was significantly higher in the surgical treatment group (p=0.001). There was no difference in treatment failure between patients with and without concomitant spinal fractures. Conservative treatment is safe and effective for traumatic sternal fractures. Surgical treatment should be reserved for rare cases, such as imminent respiratory failure or debilitating symptomatic non-union.

ANALYSIS OF STERNAL CURVATURE PATTERNS IN PATIENTS WITH PECTUS AND CONTROL.

ABSTRACTObjective: To analyze reformatted sagittal sternal tomography images and classify sternal body curvature types, and compare different types of pectus populations with one another and with normal individuals.Methods: In total, 50 controls and 167 pectus patients were selected for chest CT to analyze the median sagittal plane, of whom 89 had pectus carinatum (mean age, 12 ± 10 years) and 78 pectus excavatum (mean age, 14 ± 10 years). Clinical types of pectus were classified as inferior, superior, or lateral pectus carinatum, and localized or broad pectus excavatum. The following types of sternal patterns were defined: gradual vertical curve, gradual posterior curve, gradual anterior curve, proximal third curve, middle third curve, distal third curve, anterior rectilinear, vertical rectilinear, and posterior rectilinear. Statistical analyses were performed to compare the different types of pectus with one another and with the control group.Results: Patients with different thoracic deformities, but with similar sternal curvature patterns, were observed. Some types of sternal curvature were significantly more frequent in certain types of pectus (p < 0,05). The gradual vertical curve and anterior rectilinear types prevailed in controls (p < 0,05).Conclusion: Some sternal curvature patterns were more frequent than the others in certain types of pectus and the controls.Level of Evidence II, Prognostic studies - investigating the effect of a patient characteristic on the outcome of disease.

R39 Rib Cage Stabilisation With 3D-Printed High-Density Polyethylene Sternal Prosthesis Post-Sternotomy Mediastinitis

Post-sternotomy mediastinitis (PSM) is a serious complication of median sternotomy. When large areas of resections are performed, the use of sternal prosthesis could be considered to ensure chest wall stabilisation and cosmesis. Commonly used materials are mesh, bone grafts and titanium plates. Internationally, the use of high-density polyethylene (HDPE) as sternal prosthesis is rare as it is an emerging prosthesis material. We present our unit’s innovative first case of rib cage stabilisation with 3D-printed HDPE sternal body prosthesis.

Epidural blockade in thoracic surgery: a case report

This report presents a clinical case of the treatment of pain syndrome in isolated chest trauma following an accident of a patient with liver cirrhosis and hypocoagulation syndrome who sustained bilateral fracture of the ribs (II, III, IV, V, and VI ribs on the right and II, III, IV, V, and VI ribs on the left), fracture of the sternum body in the middle third, bilateral hemopneumothorax, and contusion of both lungs. From the initial hours, fentanyl, which was administered intravenously in a complex of multimodal analgesia, was used for anesthesia. However, adequate pain control was not achieved. Against the background of pain syndrome, the patient developed impaired consciousness and respiratory failure. Epidural puncture and catheterization with an epidural injection of ropivacaine were performed, which relieved the pain syndrome and helped prevent pulmonary complications. The present case highlights the need for an individual assessment of the riskbenefit ratio of the use of epidural catheterization in patients with coagulopathy.&#x0D; Conclusion: The use of epidural analgesia for chest trauma in patients with moderate coagulopathy made it possible to initiate effective analgesia and reduce the risk of respiratory complications, which ultimately ensured a favorable outcome of severe trauma.

Percutaneous image-guided sternal biopsy: a cross-institutional retrospective review of diagnostic yield and safety in 50 cases.

Image-guided sternal biopsy may be technically daunting given the immediately subjacent critical structures. There is a paucity of literature describing technique, safety, and efficacy. This study aims to quantify the diagnostic yield and safety of image-guided sternal biopsies. Secondary aims include (1) describing the preferred approach/technique and (2) identifying imaging features and disease entities associated with higher and lower diagnostic yields. A retrospective review of 50 image-guided sternal biopsies performed at two quaternary care centers from 2000 to 2019 was performed. Recorded lesion-related variables included as follows: location, density, extraosseous extension, and size. Recorded variables from electronic medical records included as follows: patient demographics, histologic or microbiological diagnosis, and complications. Recorded technique-related variables included as follows: needle obliquity, type, and gauge; biopsy core number and length; and modality. Of the 50 biopsies, 88.0% resulted in a definitive histologic diagnosis. Six biopsies were non-diagnostic. The majority of biopsies were performed under computed tomography (88.0%), followed by ultrasound (12.0%). Tumor was the most common biopsy indication (90.0%), followed by infection (10.0%). Of the diagnostic biopsies indicated for tumor, 88.9% were malignant. Seventy-four percent of the lesions were predominantly lytic. Fifty percent of lesions had extraosseous extension. Lesion locations were as follows: manubrium (48.0%), sternal body (48.0%), and sternomanubrial joint (4.0%). No minor or major, acute, or delayed procedure-related complications were encountered. Image-guided sternal biopsy is an efficacious and safe method of obtaining a definitive histologic diagnosis regardless of lesion-specific features or location.

Long-Term Metabolic Assessment of Cryopreserved Sternal Allograft: A Case Series

Sternal resection and reconstruction with cryopreserved allografts provides a safe alternative to traditional methods of anterior chest wall reconstruction. Despite favorable results, successful integration of the graft sternum has never been demonstrated owing to the invasiveness of bone biopsy. We describe our experience of using 18F-sodium fluoride positron emission tomography/computed tomography scans as a noninvasive method of evaluating graft integration. Seven patients underwent surgery and radiologic follow-up. Surgical indications were sternal metastases (n= 5) and sternal dehiscence (n= 2). Sternal reconstruction was performed using a cryopreserved cadaveric sternal allograft fixed in place with titanium plates and screws. Follow-up with 18F-sodium fluoride positron emission tomography/computed tomography scans was performed at 1 and 2 years after surgery. Three patients underwent total sternectomy. Two underwent partial upper sternectomy involving the manubrium, clavicle (1 patient only), and upper sternal body; and 2 had partial sternectomy of the sternal body and xiphoid process. Focal tracer accumulation occurred at the junctions between native bone and graft bone. The median maximum standardized uptake value at 1 year was 16.8 (range, 11.2 to 37.9; interquartile range, 13.6 to 19.4), and at 2 years it was 10.8 (range, 6.1 to 30.2; interquartile range, 8.9 to 15.1). In 6 cases accumulation was lower at the second scan, whereas in 1 patient the accumulation was higher at the second scan. Sternal reconstruction with cryopreserved allograft is safe and well tolerated. The 18F-sodium fluoride positron emission tomography/computed tomography scans are a useful and promising noninvasive method of demonstrating the metabolic activity of the graft and its incorporation into the host skeleton during follow-up.

Evaluation of sternal morphology according to age and sex in multidedector computerized tomography

Objectives: The sternum is located in the middle of the anterior wall of the thoracic cage. It consists of three parts; manubrium, body (corpus) and xiphoid process. Since it is an easy bone to scan, it can be used for age and sex determination in forensic medicine. The aim of the study was to investigate the characteristics of the sternum according to age and gender. Methods: This study was performed retrospectively on 700 CT images. 3D volume rendering images of sternum were created from the axial CT images at a 1 mm slice thickness. Results: There were significant differences in sternum measurements according to age and sex. The xiphoid process was identified under three different types. Ossification between the manubrium and sternum body showed significant differences according to age and sex. Conclusion: Data collected from a single bone is important for age and sex prediction especially in forensic medicine. These data taken from a large series may also contribute to evaluation of variations in sternal morphology.

Treatment of children with a rare form of congenital chest deformity

Purpose : to demonstrate cases of effective treatment of a rare manubrio-cartilaginous chest deformity in children. Methods : surgery of manubrio-cartilaginous type of sparrowy chest was performed in three 13–14-yearold adolescents accounting to 2.2% of all patients with SC. An original method of wedge resection at the site of sternum deformity (at the border of the handle and the body), video-assisted longitudinal incomplete sternotomy and elevation of the sternal body using Nuss-procedure that corrects the funnel deformation of the chest was utilized to treat the rare type of deformity. The metal structure that ensured a stable ratio of the sternocostal complex in the corrected position was removed in 1 year. Results : no functional disturbances of the chest were available during SC. The surgery was performed following cosmetic indications. Two adolescents completed their treatment 4 years ago. The chest shape was almost correct. The third patient is receiving treatment with the installed metal construction. In all three cases adolescents and their parents were satisfied with the surgery outcomes and esthetic condition of the anterior chest part. Thus, using the above described therapeutic tactics in this type of chest deformity produced a good cosmetic result.

No Need for Sternal Fixation in Traumatic Sternovertebral Fractures: Outcomes of a 10-Year Retrospective Cohort Study.

Study Design:Retrospective cohort study.Objectives:Combined sternal and spinal fractures are rare traumatic injuries and present a high risk of spinal and thoracic wall instability. Limited research has addressed the treatment of sternovertebral injuries and biomechanical need for sternal fixation to achieve spinal healing.Methods:A 10-year retrospective cohort study was conducted, including patients with sternovertebral fractures admitted to our level-1 trauma centre between 2007 and 2016. Patients who died during hospital admission, military patients, patients with isolated upper cervical spine or lower lumbar spine fractures, and patients lost to follow-up were excluded.Results:In 10 years, 73 patients with sternovertebral fractures were included. Mean injury severity score was 24 (range 4-57). Most sternal fractures were located in the sternal body and manubrium. Spinal fractures were type A (52%), B (40%), or C (8%), and were located in the subaxial cervical (21%), upper thoracic (16%), thoracic (21%), thoracolumbar (47%) area; 7 patients had spinal fractures at multiple levels. Fourteen patients (19%) had a neurological deficit. A total of 42 patients received conservative and 31 patients received operative spinal treatment. Two patients (3%) underwent primary sternal fixation. Sternal failure rate was 1% and biomechanical spinal failure rate was 8%, there was no difference in treatment failure between surgical and conservative spinal treatment. Associated thoracic injuries did not influence sternal or spinal treatment outcomes.Conclusions:These findings indicate that conservative sternal treatment in presence of spinal fractures is safe and effective. The low spinal treatment failure rates imply that sternal fixation is not necessary to achieve spinal stability.

Multidisciplinary surgical intensive treatment of an extended thoracic wall infiltration by a giant breast sarcoma: a case report

: Primary breast sarcoma represents less than 0.1% of breast cancers and less than 5% of all sarcomas. It derives from the mesenchymal tissues of the breast and can originate a histologically heterogeneous group of neoplasms. It has a poor prognosis and the median 5-year overall survival is 63.5% (range, 55–73%). Currently, diagnosis and treatment of this neoplasm are a challenge for pathologists, surgeons and oncologists. We describe the case of a 56-year-old Macedonian woman, who presented with local recurrence of a high-grade chondrosarcoma of the right breast. She had been treated elsewhere six months earlier with radical mastectomy and ipsilateral axillary dissection. The actual heteroplasia was 29 centimeters wide, ulcerated and infected. The computed tomography (CT) scan documented infiltration of pectoralis muscles, of III and IV right ribs and sternal body, but no distant metastases. Considering the patient’s clinical conditions and stage of the disease, a multidisciplinary discussion lead to the decision to attempt surgery. A multidisciplinary surgical teamwork was indispensable for attempting such a highly complex and demolitive surgery and a challenging reconstruction of the thoracic wall and an intensive post-operative monitoring of the patient was needed to manage complications related to tissue loss. Nowadays it is difficult to find patients suffering from tumors of this size and consequently the treatment is made more complicated by the lack of experience. With this case report we share our experience in the treatment of an infrequent pathology that has presented itself to us with dimensions rarely reported in the literature.

Anterior chest wall resection and sternal body wedge for primary chest wall tumour: reconstruction technique with biological meshes and titanium plates.

Chest wall tumours are heterogeneous neoplasms, either primary or metastatic, with a malignancy rate of 50%. Surgical resection is one of the mainstays of the treatment, however, chest wall resections can be particularly challenging depending onto the resection size, site and patient habitus. The surgical strategy should be carefully analysed preoperatively, keeping in mind the need of an oncological radical resection (R0) in accordance to the reconstruction principles elicited by le Roux and Sherma since 1983, which include restoring the chest wall rigidity, preserving pulmonary mechanics, protect the intrathoracic organs, avoiding paradox movements of the chest cavity and, possibly, to reduce the thoracic deformity. In this context, we herewith report our surgical reconstruction technique following an anterior chest wall resection and sternal body wedge for a primary chest wall tumour (chondrosarcoma).

Inter- and intra-observer variability of the AO/OTA classification for sternal fractures: a validation study.

Recently, a new classification system for sternal fractures has been published in the Journal of Orthopedic trauma by the Arbeitsgemeinschaft für Osteosynthesefragen (AO) foundation and the Orthopaedic Trauma Association (OTA). The aim of this study was to evaluate inter- and intra-observer variability of the AO/OTA classification for sternal fractures. Twenty multidetector computed tomography (CT) scans of patients with sternal fractures were classified independently by six senior and six junior orthopedic trauma surgeons of two level-1 trauma centers. Assessment was done on two occasions with an interval of 6weeks. The kappa value was calculated to determine variability. The inter-observer variability of the AO/OTA classification for sternal fractures showed fair-to-moderate agreement (kappa = 0.364). There was no significant difference between junior and senior surgeons. Analyses of the separate components of the classification demonstrated that agreement was lowest for classifying fracture type within the sternal body (kappa = 0.319) followed by manubrium (kappa = 0.525). The intra-observer variability showed moderate agreement with a mean kappa of 0.414. The inter- and intra-observer variability of the AO/OTA classification for sternal fractures shows fair-to-moderate agreement. The overall performance of the classification might be improved with minor modifications. Diagnostic cross-sectional study (level I).

Sternal resection and reconstruction with a multi-functional modular prosthesis

Reconstruction for a large area of sternal defect is challenging. The available sternal reconstruction techniques and materials have their limitations. We designed a modular sternal reconstruction system made of titanium alloy. This system was applied to a patient who received partial sternal resection for well-differentiated chondrosarcoma of the sternum. The sternal neoplasm measured 80×70 mm2. After resection of most of the sternal body and adjacent ribs, standard modules of adequate types and sizes were chosen and assembled during operation. The operation lasted for 240 min, with an intraoperative blood loss of 100 mL. The patient was followed up for 32 months, while the prosthesis remained stable, with no signs of infection or looseness.

Reliability of Cardiac Percussion Technique to Determine Left Ventricular Size in Comparison with Cardiothoracic Ratio and Transthoracic Echocardiography

Background Cardiac percussion (CP) is a bedside technique to evaluate cardiac borders, chamber size and extent of pericardial fluid. Although advanced cardiac imaging techniques have revolutionized the methods to detect cardiomegaly, the art of cardiac percussion remains the most convenient option especially in emergent situations. Despite transthoracic echocardiography (TTE) is considered accurate to determine left ventricular size, CP can estimate left ventricular size with equal accuracy as TTE in an appropriate clinical setting, We aim to investigate the correlation of left ventricular size by using the CP technique and compare it with standard TTE as well as cardiothoracic ratio(CTR) on chest roentgenography. Methods This descriptive study was conducted on the Telemetry unit in BronxCare Health System. In this bedside technique, as a part of physical examination, the patient was positioned at a Gatch angle of 30-45 degrees. Cardiac dullness was assessed by percussing from the mid clavicular line toward the gladiolus of the sternal body. A ruler was then utilized to measure the left ventricular size (in centimeter) and the reference point (middle left parasternal border). Subsequently, we correlated findings with TTE dimensions of left ventricular end-diastolic diameter (LVEDD) during the same hospitalization. Additionally, we assessed the CTR on chest roentgenography (CXR). Percussors were blinded from clinical history and imaging findings. Teicholz method was used to calculate left ventricular (LV) volumes. Coefficient of variation (COV) was used to estimate the variability in each estimate. Bland-Altman plots were created to compare any pair of measurements with Pitman's test to examine the difference in variance between the two measurements. Results The average age of our 200 patients was 63(± 15.81) year with females constituting 51% of the population. The average BMI was 28.5 KG/M2 with 33% had normal BMI. Among the subjects included, 22% were observed to have heart failure diagnosis. The LV diameter measured by CP technique was observed similar to LVEDD measured by TTE (Mean 4.65cm ±0.67 versus 4.69cm±0.76, COV 7.6%). The LV diameter measured by CXR was observed to have no correlation with LVEDD (5.79cm±1.21, COV 14.3%, r=-0.475, p Conclusions CP technique is a convenient bedside method that can be utilized to assess LV size and volume. It's shown to have a precise correlation with LVEDD measured by TTE. CXR was not observed to have any correlation in the estimation of LV size. The study emphasizes the role of bedside estimation of LV size by using physical examination technique. Future studies are required to validate our findings.

Sex estimation of the sternum by automatic image processing of multi-slice computed tomography images in a Croatian population sample: a retrospective study

AimTo determine the sexual dimorphism of the sternum with standard measurements in a contemporary Croatian population sample using multi-slice computed tomography (MSCT) and to compare the data obtained by an automatic with those obtained by a manual approach.MethodsFive sternal measurements were obtained from MSCT images of 73 men and 55 women and three sternal indices were calculated. Custom image analysis software was developed for automatic segmentation and calculation of sternal measurements. Measurements of sexual dimorphism were automatically calculated and compared with manual measurements.ResultsAll of the sternal measurements exhibited significant differences between men and women. The discrepancies between manual and automatic measurements ranged from 2.8% to 3.6% of the mean average values obtained with the automatic approach. The most accurate single-variable discriminant function was sternal body length (82.8%), the most accurate index was sternal area (89.1%), and the discriminant function using three variables was manubrium width, sternal body length, and sternal body width (90.6%).ConclusionSternal measurements are a reliable sex indicator and can be used in forensic casework. Computer-aided measurement methods can accelerate sex estimation and improve its precision and accuracy.

Use of accelerometers for automatic regional chest movement recognition during tidal breathing in healthy subjects

Recognition of breathing patterns helps clinicians to understand acute and chronic adaptations during exercise and pathological conditions. Wearable technologies combined with a proper data analysis provide a low cost option to monitor chest and abdominal wall movements. Here we set out to determine the feasibility of using accelerometry and machine learning to detect chest-abdominal wall movement patterns during tidal breathing. Furthermore, we determined the accelerometer positions included in the clusters, considering principal component domains. Eleven healthy participants (age: 21 ± 0.2 y, BMI: 23.4 ± 0.7 kg/m2, FEV1: 4.1 ± 0.3 L, VO2: 4.6 ± 0.2 mL/min kg) were included in this cross-sectional study. Spirometry and ergospirometry assessments were performed with participants seated with 13 accelerometers placed over the thorax. Data collection lasted 10 min. Following signal pre-processing, principal components and clustering analyses were performed. The Euclidean distances in respect to centroids were compared between the clusters (p < 0.05), identifying two clusters (p < 0.001). The first cluster included sensors located at the right and left second rib midline, body of sternum, left fourth rib midline, right and left second thoracic vertebra midline, and fifth thoracic vertebra. The second cluster included sensors at the fourth right rib midline, right and left seventh ribs, abdomen at linea alba, and right and left tenth thoracic vertebra midline. Costal-superior and costal-abdominal patterns were also recognized. We conclude that accelerometers placed on the chest and abdominal wall permit the identification of two clusters of movements regarding respiration biomechanics.

Gross morphological studies on the sternum of crested serpent eagle (Spilornis cheela)

The present study was designed to elucidate the morphological characteristics of sternum of crested serpent eagle. The sternum was a thin, flat bone with a body, rostrum and keel. The body was quadrilateral plate with concave dorsal and convex ventral surfaces and four borders. Numerous pneumatic foramina were present on the dorsal surface. The ventral surface presented a large, boat shaped keel along its median line. The cranial border was convex and thick and two pneumatic foramina were present behind the cranial border on the ventral surface of sternum. The facets for coracoid bones were located just below the cranial border. The lateral border on either side presented six articular facets for sternal ribs. The triangular pointed cranio-lateral process was observed at the junction of cranial and lateral border on either side. The caudal border was convex and caudo-lateral processes were absent. Two distinct oval foramina were seen near the caudal border. The rostrum or sternal spine was smaller and located just below the cranial border of the body of the sternum. The sternum presented a well-developed triangular keel located along the midline of the ventral surface of the body of sternum.

Determination of Sex from the Length of Mesosternum (Body of Sternum) in Indore Region, Madhya Pradesh

Introduction: Skeletal remains or decomposed bodies are an important initial step in forensic investigation. Determination of skeletal Sex from unknown mutilated and decomposed bodies has been a critical issue in medico legal cases and the accuracy depends on the nature and types of material available and methods applied. Sternum is a bone which is easily retrievable even from the advance decomposed, mutilated body and also from the bundle of bone so it become very important bone for age and sex determination.