Sternal Measurements Research Articles

Sternal bone anatomy on preoperative imaging as an independent predictor of deep sternal dehiscence following median sternotomy

Complications following median sternotomy are associated with morbidity, mortality, and major healthcare costs. With plastic surgeons being increasingly consulted to close complex sternotomy wounds, a more accurate risk stratification tool for this comorbid patient population is warranted. This study examines the association of preoperative radiologic sternal measurements and deep sternal dehiscence, comparing this with other known clinical risk factors. A decreased manubrium sternal thickness relative to body weight (<0.13mm/kg) and an absolute inferior sternal width ≤13.8mm had a significant association with the development of deep sternal dehiscence, even with adjustment for known clinical risk factors. With such measurements assisting in further risk stratification, the opportunity to improve risk assessment holds value for plastic and reconstructive surgeons who are consulted to close extensive sternotomy wounds.

Estimation of Stature from the Length of the Sternum in the Ethnic Meitei Population– A Study in Medicolegal Autopsies

Identification is necessary for living persons, dead persons, decomposed bodies, and mutilated and burnt bodies. In some cases where long bones are not available; the fresh sternal length can be used for stature estimation. Forty male cases belonging to the ethnic Meitei population within the age group 14-70 years were studied. Linear regression analysis was applied for the different sternal lengths to derive regression equations for the estimation of the stature of the study population. The linear regression obtained for the length of the manubrium, length of the body, combined length of the manubrium and the body and the total sternal lengths were Y=5.7641X +138.53, 1 Y=2.277X +140.6, Y=2.3229X +128.81 and Y=2.4786X +116.05 respectively. The maximum correlation was observed for the total 2 3 4 sternal length (R=0.569) followed by manubrium (R=0.475), the combined length of manubrium and mesosternum (R=0.462) and mesosternum (0.374). The study showed that there was a moderate positive correlation between all the sternal measurements with the cadaveric length.

Applicability of the hour of life approach in hyperbilirubinemia among Filipino term infants.

BackgroundHyperbilirubinemia remains a common morbidity among infants. Additional research on bilirubin kinetics and associated risk factors will contribute to providing a more targeted management approach for the Filipino infant.ObjectiveTo develop a Filipino bilirubin nomogram by studying bilirubin patterns during the first 5 days of life.MethodologyThis prospective study recruited 1,412 stable, full-term infants (≥37 weeks age of gestation) born at the Philippine General Hospital (PGH). Using the Dräger-Minolta JM-103 jaundice meter, transcutaneous bilirubin (TcB) levels were determined at the 3rd, 6th, 12th, 24th, 36th, 48th, 72nd, 96th, and 120th hour of life (HOL). A bilirubin nomogram was created using the averages of 3 TcB forehead and sternal measurements at each time epoch. Simultaneous measurement of TcB and total serum bilirubin (TsB) on a subset of 106 infants was done to determine correlation.ResultsCorrelation coefficients were high between TsB and forehead TcB (r2 = 0.88), and between TsB and sternal TcB (r2 = 0.91). The Filipino bilirubin nomogram reflected a steep rise until the 48th hour, followed by plateauing of values. Inadequate nursing and bilirubin levels at 12th and 48th HOL were risk factors for developing significant hyperbilirubinemia at 72nd HOL.ConclusionTcB is a reliable, non-invasive bilirubin screening tool. Among healthy, full-term, Filipino infants, their nomogram features a sudden increase in bilirubin values during the first 48 h, followed by a plateau. To aid in identification of infants at risk for significant hyperbilirubinemia, healthcare providers can assess breastfeeding adequacy and perform bilirubin screening at the 24th−48th HOL. Registration No. (RGAO-2016-0686).

Determination of Gender from Sternal Measurements Using Computed Tomography Imaging in a Sample of Sohag Governorate Population.

Determination of Gender from Sternal Measurements Using Computed Tomography Imaging in a Sample of Sohag Governorate Population.

Anthropometry of the sternum: An autopsy-based study for sex determination.

Sex determination is one of the key components for establishing the individual's identity in forensic anthropology casework. It is a known fact that anthropometric assessment can have population-specific variations. The present autopsy study was conducted on the sterna of 102 cadavers (52 males and 50 females) of age more than 25 years at a tertiary care centre in Central India. Anthropometric measurements included the length of the manubrium (M), mesosternum (B) and combined length of manubrium and mesosternum (CL). Applicability of Hyrtl's law, Ashley's rule and the sternal index were also assessed for sex determination. A statistically significant correlation (p < 0.001) was observed between sternal measurements and the sex of the study population. The highest coefficient of correlation was seen between sex and the combined length (r = 0.726), followed by mesosternal length (r = 0.620), and manubrial length (r = 0.509). The difference between the means of the sternal index in males and females was not statistically significant (p > 0.05), and the difference between the means of the ratio of the body with manubrium in males and females for Hyrtl's law is also not found to be statistically significant (p > 0.05). It is concluded that the length of the body and the combined length of manubrium and mesosternum are valuable criteria for sexing the sternum in an adult population of Central India. The sternum can be useful for sex determination, particularly when bones like skull, pelvis, or long bones are not available or fragmented.

Estimation of sex based on metrics of the sternum in a contemporary Jordanian population: A computed tomographic study.

There is a paucity of osteometric standards for sex estimation from unknown skeletal remains in Jordan and the sexual dimorphism of the sternum has not yet been investigated. The aim of this study was to evaluate the sexual dimorphism in sternal measurements using 3D multidetector computed tomography (MDCT), and to assess their reliability for sex estimation in a Jordanian population. A total of 600 MDCT scans (300 males and 300 females) were used and a total of 8 sternal measurements were studied (manubrium length, sternal body length, combined length of manubrium and body, corpus sterni width at 1st and 3rd sternebrae, sternal index and area). Sexual dimorphism was evaluated by means of discriminant function analyses. Significant sexual dimorphism was found mainly in middle-aged and older adults. Including all subjects, multivariate, and stepwise functions gave an overall accuracy of 83.0% and 84.0%, respectively. Additionally, multivariate and stepwise analyses were conducted separately for each age group. The accuracy of sex estimation in multivariate analysis (all variables) varied from 63.2% in the young, and 83.7% in the middle adults to 84.9% for older adults. In stepwise analysis, the highest accuracy rates were provided by only sternal area in young adults (81.6%), and sternal area combined with sternal body length in middle-aged and older adults (84.2% and 85.3%, respectively). The best sex discriminator using univariate analysis (single variable) was sternal area followed by sternal body length (84.0% and 80.8% respectively). Notably, univariate analyses for most variables gave relatively higher classification accuracies in females but were poor at predicting males in the sample (sex bias ranged between −6.4% and −20%). Our data suggest that dimorphism in the human sternum increases with advancing age and separate discriminant functions are needed for each age group in Jordanians. In addition, multivariate and stepwise analyses using sternum gave higher classification accuracies with comparatively lower sex biases compared to univariate analyses.

Sternum as an indicator for sex and age estimation using multidetector computed tomography in an Egyptian population

• Age and sex estimation techniques using the sternum were tested on an Egyptian population. • The logistic regression formula for estimating sex demonstrated 88.3% accuracy. • Fusion of the manubrio-sternal and xiphi-sternal joints were of limited use for age estimation, with binary logistic regression accuracies ranging from 63.6-75.0%. Introducing advanced radiographic techniques, like CT, in the field of forensic human identification is crucial. Sex and age are important biological attributes to be estimated during forensic identification process. The diagnostic value of sternum as an indicator for accurate sex and age estimation for an Egyptian population is still questionable. Therefore, this study aimed to evaluate the validity of sex estimation using sternal metric measurements and age estimation using fusion of manubrio-sternal joint (MSJ) and xiphi-sternal joint (XSJ) on MDCT images of a sample of Egyptian population. For sex estimation, a total of 165 MDCT images were assessed. Five sternal measurements were assessed on 88 MDCT images of known sex to develop a logistic regression equation which was then tested for its validity on 77 MDCT images of unknown sex. For age estimation, 88 MDCT images of known age were assessed for MSJ and XSJ fusion stages. Logistic regression analysis was done to denote the accuracy of estimating age (above or below 45 years) for both sex-specific and pooled-sex samples. For sex estimation, validity of logistic regression equation was as follows: sensitivity (85.7%), specificity (90.5%), and accuracy (88.3%). As regards to age, MSJ and XSJ fusions were highly variable and overall logistic regression results demonstrated low accuracy rate. We concluded that sternal measurements assessed using MDCT may represent a valid metric method for sex estimation in Egyptian population. On the other hand, MSJ and XSJ fusion stages were of limited value for age estimation.

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.

Estimation of cadaveric stature from sternal measurements: An autopsy-based study

The aim of this study was to estimate cadaveric/post-mortem stature from dry sternum measurements by deriving regression equations. This study included dry intact sterna from 56 males and 44 females, aged more than 25 years, obtained during medico-legal autopsies. Stature and three sternal lengths i.e. length of the manubrium (ML), Mesosternal length (MSL) and combined sternal length (MBL), of each cadaver were measured. Stature and all measured sternal lengths were greater in males compared to females (p<0.001). Most of the sternal lengths were positively correlated with stature in sexes except male MSL and MBL. MBL had the highest correlation coefficient (0.525). On the other hand, the stepwise multiple linear regression equation derived from the combination of ML, MSL and MBL had the higher R2 value (R2 = 0.337) for cadaveric stature estimation. These findings suggested that measured sternal lengths can be used for estimation of sex. However, MSL and MBL measurements were found to be the most reliable sternal lengths for estimating sex. Our results revealed that sternum morphometry although shows moderate positive correlation with the cadaveric stature but is not a reliable tool for estimating stature when other skeletal bones are not available.

A Study for Determination of Sex by Multidetector Computed Tomography of Sternum using Discriminant Function and Logistic Regression

Post-mortem investigations of skeletal remains as well as radiographs from living individuals provide useful information for the discrimination of sex. Our study aimed to find out a mathematical model to differentiate gender based on greater degree of accuracy than the anthropological measures taken from the sternum obtained from cadaver dissection. The study was performed on 108 adults who were brought for examination of chest due to various medical reasons. Their age ranged between 18 and 80 years. The cases were selected randomly after considering the inclusion and exclusion criteria. Sternal measurements were taken by studying CT (Computed Tomography) scans. Of these cases, 73 were males and 35 were females. The discriminant function equation (Df) = 0.071 Manubrial Length +0.075 Manubrio-Sternal Length +0.036 Width at S1 +0.037 Width at S3 -11.367 (Constant). Overall 80.6% of the sample was correctly classified into their group. This study revealed that measurements from CT scan of sternum can be used to differentiate between sex of individuals which adds to a great advantage in forensic anthropology.

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.

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

Estimation of stature from sternum – Exploring the quadratic models

Identification of the dead is significant in examination of unknown, decomposed and mutilated human remains. Establishing the biological profile is the central issue in such a scenario, and stature estimation remains one of the important criteria in this regard. The present study was undertaken to estimate stature from different parts of the sternum. A sample of 100 sterna was obtained from individuals during the medicolegal autopsies. Length of the deceased and various measurements of the sternum were measured. Student's t-test was performed to find the sex differences in stature and sternal measurements included in the study. Correlation between stature and sternal measurements were analysed using Karl Pearson's correlation, and linear and quadratic regression models were derived. All the measurements were found to be significantly larger in males than females. Stature correlated best with the combined length of sternum, among males (R = 0.894), females (R = 0.859), and for the total sample (R = 0.891). The study showed that the models derived for stature estimation from combined length of sternum are likely to give the most accurate estimates of stature in forensic case work when compared to manubrium and mesosternum. Accuracy of stature estimation further increased with quadratic models derived for the mesosternum among males and combined length of sternum among males and females when compared to linear regression models. Future studies in different geographical locations and a larger sample size are proposed to confirm the study observations.

Estimation of sex in a contemporary Saudi population based on sternal measurements using multidetector computed tomography

Sex estimation is an essential step for identifying unknown individuals and usually depends on the presence of highly dimorphic bones, such as the pelvis and skull. Nevertheless, the body integrity can be compromised in certain circumstances, and these bones might be absent; therefore, the ability to use other bones for sex estimation is crucial. The aims of this study were to collect baseline data for sternal dimensions in Saudi adults, assess the existence of sexual dimorphism in the sternum, and generate population-specific equations to estimate sex using sternal dimensions. During 2014–2015, 200 thoracic/thoraco-abdominal computed tomography (CT) images (100 men, 100 women) were anonymously collected from King Abdulaziz Medical City. Six measurements were obtained and two indices calculated after 3D reconstruction of the CT scans. Descriptive statistics were calculated, and sexual dimorphism was assessed using independent t-tests. Discriminant function equations were developed for these measurements. Except for the sternal index, men had significantly larger dimensions than women. Sexual dimorphism was highly significant (p<0.001). The best predictor was the combination of the manubrium and sternal body lengths (89.5%). In the stepwise analysis, the best predictors were the manubrium length, sternal body length, manubrium width, and corpus width at the first sternebra, with a cross-validated accuracy of 90.5%. Cross-validated accuracy for all measurements ranged between 62.5% and 90.5%. The findings of the study may have important anatomical, anthropological, and forensic applications.

Sex determination from chest measurements in a sample of Egyptian adults using Multislice Computed Tomography

BackgroundIn forensic sciences to determine one's sex is quite important during the identity defining stage. The reliability of sex determination depends on the completeness of the remains and the degree of sexual dimorphism inherent in the population. Computed Tomography is the imaging modality of choice for two- and three-dimensional documentation and analysis of many autopsy findings. ObjectiveThe aim of the present work was to assess the reliability of Three-dimensional Multislice Computed Tomography (3D MSCT) to determine sexual dimorphism from certain chest measurements; sternum and fourth rib using the 3D MSCT and to develop equations for sex determination from these bones among adult Egyptians sample. Subjects and methodsThe present study was performed on 60 adult Egyptians. Their age ranged from 21 up to 74 years and they were equally divided between both sexes. Sixty virtual chests (reconstructed Multislice Computed Tomography 3D images) were examined for detection of Sternal measurements; Manubrium length (ML), Sternal body length (BL), Manubrium width (MW), Sternal body widths(BWa&BWb), Sternal area (SA) [(ML + BL) × (MW + BWa + BWb)/3]and Fourth rib width (FRW). ResultsAll the studied measurements were significantly higher in males than in females. Multiple regression analysis was used to and three significant regression equations were developed for predicting sex using the different studied chest measurements; the sternal measurements, the sternal area and the widths of the right and left fourth ribs with their accuracies 96.67%.95.0%.72.68% respectively. ConclusionSterunm and fourth rib width revealed significant metric sex differences with the use of Multislice Computed Tomography 3D images thus provide a great advantage in the analysis of skeletal remains and badly decomposed bodies.

Sex estimation from discriminant function analysis of clavicular and sternal measurements: a forensic anthropological study based on examination of two bones of Northwest Indian subjects

The clavicle and the sternum are important bones of the anterior thoracic skeleton that are commonly found well preserved in forensic contexts. To assess the concurrent suitability of two bones of the same individual in forensic sex estimations, both clavicles and sternums were collected from 252 male and 91 female autopsy cadavers. This study’s bone dimensions were found to be significantly smaller than of subjects of other nationalities and also higher than previous Indian studies. Statistically significant sex differences were noticed in different dimensions of the two bones (p < 0.001). The univariate DFA found that the product index of the clavicle and combined sternal length were the best sex discriminating variables to identify the sex of about 85% of the cadavers. From the multivariate discriminant function analysis of all linear variables (DF: –18.664 + 0.107 (MCI–L) + 0.180 (MCC–R) +.045(MBL) – 0.071(MDL–L), the sex of 90.7% of the cadavers could be estimated correctly and this percentage was highest when either clavicular or sternal measurements were used in the analyses. The concurrent use of the two bones provided higher accuracy levels with lower sex biases than the individual use of either bone in univariate or multivariate analysis. The clavicle was found to be better and more reliable than the sternum for sex estimations in the current autopsy samples. Further studies are needed to corroborate or negate the findings of these investigations.

Sex determination from different sternal measurements: A study in a Thai population

IntroductionEstimation of sex is an important initial step for personal identification of unknown skeletal remains in forensic investigation. The aim of the present study was to evaluate the applicability of the sternum for sex estimation of adult skeletal remains by measuring the sternum of Thai individuals. MethodsA study of 281 adult Thai dry sterna with known sex (192 males and 89 females) was carried out for sexing by using measurements. Discriminant function analysis was used. ResultsThe results showed that all parameters included in this study were significantly sexually dimorphic except sternal width index. By using discriminant function analysis, it was observed that the best parameter was the combined length of manubrium and mesosternum yielded cross-validated sex allocation accuracy rate 85.8% (82.4% for male and 95.7% for female), followed by sternal area with classification accuracy rate 82.9% (79.2% for males and 91.2% for females) and the length of mesosternum with classification accuracy rate 81.1% (78.8% for males and 88% for females). A stepwise discriminant function, which included 5 linear measurements from both manubrium and mesosternum yielded highest classification accuracy rate of 86.4%. DiscussionThe results of the present study proved that the sternum is a reliable element for sex determination in Thai population and it may be a useful tool in forensic investigations.

Effect of fusion status of sternum in stature estimation – A study from South India

Forensic anthropologists examine and identify skeletal, dismembered and commingled remains in a legal context to establish the biological profile of the deceased. Stature estimation is one of the important parameters in establishing the biological profile. The present study is planned to derive regression models for stature estimation from sternal measurements. Various factors are likely to affect stature estimation in forensic investigations. Since, none of the previous researchers have studied the effect of fusion status on stature estimation from sternum and its segments, the present study attempts to find if the fusion status of the sternum affect its reliability and accuracy in stature estimation. The sample of the present study consisted of 117 sterna that were obtained from autopsied bodies. Five measurements i.e. Length of manubrium (M), length of mesosternum (B), combined length of manusbrium and mesosternum and the (M + B), width at first sternabrae (S1) and width of 3rd sternabrae (S3) were taken on the autopsied sterna. The sterna were classified as fused (both manubriosternal and xiphisternal joints were fused), partly fused (only one of the manubriosternal or xiphisternal joints was fused) and not fused (both manubriosternal and xiphisternal joints were not fused). Regression models were derived using statistical methods. All the sternal measurements show a positive however, a weak correlation with stature. Thus, it can be concluded that the accuracy and reliability of stature estimation from sternum and its segments is quite low in practical situations. Among the sterna classified based on the fusion status, the length measurements of completely fused sterna show significant correlation with the stature. None of the other sternal measurements on the non-fused or partly fused sterna show statistically significant correlation with stature. The present study concludes that the fusion status of the sternum is likely to affect the reliability and accuracy in estimation of stature. The findings of this study however, should be considered 'preliminary' until they are corroborated by similar studies based on larger samples from different populations.

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.

Estimation of sex in Japanese cadavers based on sternal measurements using multidetector computed tomography.

This study assessed the sex-discrimination potential of the sternum in a Japanese population using three-dimensional (3D) computed tomographic (CT) images. A total of 200 cadavers (100 males, 100 females) who underwent postmortem CT and subsequent forensic autopsy between December 2011 and June 2014 were used. Five measurements of each sternum were performed on 3D CT reconstructed images that extracted only bone data, and two sternal dimensions and three indices were calculated. Univariate discriminant function analyses using these linear measurements and calculated sternal dimensions and indices yielded sex classification accuracy rates of 62.5-84.0%, and 63.0-90.5%, respectively. The results of this study indicate that sternal measurements may be useful for the forensic assessment of sex in Japanese individuals, particularly in cases where better predictors, such as the pelvis or skull, are unavailable.