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PubMed1999

[Surgical treatment of chronic osteomyelitis of the sternum and the ribs].

Transsternal approach is commonly used in majority of operations in heart surgery. In 0.5-5.9% of patients after median sternotomy osteomyelitis of the sternum and the ribs develops. The authors set forth their experience in surgical treatment of 182 such patients. In 97% of them total resection of the sternum was combined with simultaneous resection of costal cartilages which were involved in pyogenous inflammatory process. Costal cartilages were resected during subtotal resection of the sternum in 95% of cases and ribs--in 25%. Limited resection of the sternum was used only in patients with suppuration in the area of sutures in the sternum. Radical one-stage resection of the pyogenous site at the anterior thoracic wall was carried out in 62 patients. In 120 patients in poor condition and who previously underwent an opening of the abscess, staged surgery (2 or more operations) was performed. The authors suggest that in patients with cardio-pulmonary and hepato-renal insufficiency it is advisable to repair the defect, developed after resection of the thoracic wall, by split and perforated cutaneous flap. Muscular flap (32 patients) and greater omentum flap (30 patients) with vascular pedicles or local tissues (28 patients) were used for plastics of the thoracic wall defects. In 98 patients for the closure of the defect autodermoplasty with free split perforated cutaneous flap was used, otherwise the wound of the thoracic wall in them recovered by secondary intention type. 168 (92%) patients have recovered, 4 patients developed recurrence of osteomyelitis, 10 patients died. The authors suggest that the treatment of such serious patients should be carried out in specialized departments which have experience in thoracic, purulent and plastic surgery.

Bacteria↗
PubMedDate not supplied

Eosinophilic granuloma of sternum. Report of one case.

A rare case of solitary eosinophilic granuloma of the sternum in a 5-year-old boy is reported. He presented anterior chest pain and a nodular, somewhat tender mass over the sternum. Chest x-ray, tomography, CT scanning of the sternum and total body Gallium scanning revealed an isolated lytic lesion 5 cm below the sternal angle. An excisional biopsy of the mass showed the typical histologic appearance of eosinophilic granuloma. An isolated eosinophilic granuloma of sternum is rarely reported in the English literature. The differential diagnosis of sternal tumors and a review of eosinophilic granuloma of sternum is discussed.

Child, Preschool↗
PubMed1980

Sexing the human sternum.

For differentiating a male from a female sternum, a metrical study of 400 adult North Indian sterna (312 males and 88 females) obtained from medicolegal postmortems was made. If the combined length of the manubrium and mesosternum was more than 140 mm. the sternum was male, and if less than 131 mm. it was female. No opinion could be given if the length was between 131 and 140 mm. By this measurement 72.12% male and 62.50% female sterna could be sexed with 100% accuracy. The length of the mesosternum alone could also determine the sex correctly in 50.32% male and 29.55% female specimens. The length of the manubrium, manubrium-corpus index, width of the first or third sterebra or their index, were not found to be useful in sexing a given sternum. By using multivariate analysis the probability of correctly identifying the sex of a sternum was over 85%.

Adult↗
PubMed1990

Case report 593: Hemangioma of sternum.

A 38-year-old woman presented with an expansile lesion of the sternum. Plain film tomograms and computed tomography showed an expansile lesion of the sternum. Bone scanning revealed increased uptake in the sternum. The neoplasm was surgically excised and proved to be a hemangioma (Fig. 4a) and 4b). The rarity of this neoplasm in the sternum was stressed. An extensive search of the literature failed to reveal a single previous report of a sternal hemangioma. A differential list of other primary benign and malignant sternal tumors was presented.

Adult↗
PubMed2006

Giant cell tumor of the sternum.

A primary giant cell tumor (GCT) originating from the sternum is extremely rare. We report a case of a GCT originating from the sternum in a 45-year-old man who was referred to us for a mass in the anterior chest wall that had been growing slowly. Computed tomography revealed a soft tissue mass involving a large osteolytic and destructive lesion of the sternum body. Subtotal sternectomy and reconstruction with methylmethacrylate were performed. The tumor was 8.5 x 4.5 x 2.5cm, and the histopathological examination confirmed GCT. Radical wide resection of primary sternum tumors and reconstruction with an appropriately rigid prosthetic material are necessary to minimize local recurrence.

Bone Neoplasms↗
PubMed1991

Resternotomy in patients with valved conduits adherent to the sternum.

Twenty-two patients with valved conduits adherent to the sternum underwent resternotomy. Mean age was 10 +/- 6 years, and mean conduit age was 4 +/- 4 years. Diagnoses were D-transposition (7), truncus arteriosus (7), univentricular heart (6), Taussig-Bing anomaly (1), and corrected transposition (1). The majority of patients (68%) had reoperation for outgrown or degenerated conduits. In 17 patients, the sternum was opened with a chisel. Two of these patients sustained conduit neointimal collapse from manipulation, and 3 had conduit tear requiring immediate cardiopulmonary bypass through the femoral vessels. In the last 5 patients, the sternum was opened above and below the conduit, and the inner table was chiseled and left attached to the conduit avoiding injury and undue conduit manipulation. Cardiopulmonary bypass and operation were carried out uneventfully. We believe that the recent technique described provides a safe alternative approach to valved conduits adherent to the sternum.

Adolescent↗
PubMed1995

Free latissimus dorsi flap for chest wall repair after complete resection of infected sternum.

BACKGROUND: Radical debridement, followed by muscle flap cover, has significantly reduced morbidity and mortality of infected sternotomy wounds. The pectoralis major, rectus abdominis, and greater omentum flaps are most commonly used, whereas the latissimus dorsi muscle is rarely employed. METHODS: In 7 patients with persistent infection and necrosis of the sternum, radical and extensive debridement including the sternum, costochondral arches, manubrium and sternoclavicular joints was performed. A free latissimus dorsi flap was used for soft tissue reconstruction without additional stabilization of the chest wall. RESULTS: All flaps survived without revision of the anastomosis. In the follow-up period (22 months to 5 years) no recurrent infection was observed. Three patients died during the study period (3 to 24 months after operation) due to causes not related to sternum operation. No additional weakness, pain, or restricted movements of the shoulders due to missing sternum was observed. CONCLUSIONS: Our findings suggest that the use of free latissimus dorsi flap after complete sternectomy for infection has several advantages: it provides abundant tissue to allow radical and extensive debridement, obliterates completely the dead space, and helps to control infection. Even without additional chest wall reconstruction it gives enough stability to allow pain-free normal daily activities.

Aged↗
PubMed1995

Age estimation on the female sternum by quantification theory I and stepwise regression analysis.

One hundred and nine sternums from Chinese females aged 18-50 years were examined in this study. Six morphological characteristics and their changing degree in the female sternum were observed and scored. The data were statistically processed by quantification theory I and stepwise regression analysis on a computer and the following regression equation for age estimation of the female sternum was calculated: y = 19.28 + 1.83x1 + 1.66x2 + 3.02x3 + 1.57x4 + 3.02x5 + 7.75x6 + 1.25x7 + 3.45x8 + 4.88x9 + 0.82x10 + 2.76x11 + 2.48x12 + 7.84x13 + 1.26x14 + 3.80x15 (the correlation coefficient R = 0.9774, the standard deviation S = 2.20, F > 0.01). For convenience, the changing degree of the morphological characters and the equation were also converted into two tables. This method of age estimation on the female sternum is simple and accurate and is of importance to forensic medicine and anthropology.

Adult↗
PubMed2001

[Ultrasound diagnosis of sternum fractures].

AIM: With the present study we wanted to examine the value of ultrasonography in the diagnosis of fractures of the sternum. METHOD: Included in this study were 11 patients with pain in the sternal region and suspected fracture of this area according to case history and clinical examination. We exclusively used a 7.5 MHZ linear scanner. RESULTS: In all 11 cases the fracture was free of doubts diagnosed using ultrasound. A fragment dislocation could be visualized in 10 cases and 1 case showed a fissure of the sternum. The standard lateral X-ray as our reference method confirmed the sonographical diagnosis in all cases. CONCLUSIONS: The diagnostical value of ultrasonography of the sternum is at least as high as that of standard lateral X-ray. When a hypoechoic area over the sternum together with a hematoma, a disruption of the cortical bone or a step in the bony outline as a sign for fragment dislocation are found, sternal fracture is the definite diagnosis. Ultrasonography is quickly feasible, non-invasive and gives sufficient information in these cases without side effects.

Adult↗
PubMed1993

Evaluation of postoperative osteomyelitis of the sternum comparing CT and dual Tc-99m MDP bone and In-111 WBC SPECT.

This article reports on a retrospective study of 32 patients who underwent CT and combined Tc-99m MDP and in-111 WBC SPECT between 1988 and 1991 for post-operative sternal osteomyelitis. Of these 32 patients, 7 patients (Group 1) underwent evaluation for possible sternal osteomyelitis due to persistent fevers, leukocytosis, or changes in the sternal incision; 12 patients (Group 2) had surgically proven osteomyelitis, and in 13 patients (Group 3) there was definite clinical evidence of sternal wound infection (however, surgical specimens of the sternum were not submitted). There was considerable overlap between the CT findings in the soft tissues adjacent to the sternum in Group 1 and Group 2 patients. Severe demineralization was seen in two patients, and erosion of the sternum was seen in five patients with proven osteomyelitis. Combined Tc-99m MDP bone and in-111 WBC SPECT was positive for osteomyelitis in 11 of 12 patients in Group 2. One patient with osteomyelitis had negative scintigraphy; however, this patient had a four-week course of IV antibiotic therapy prior to the study. All seven patients in Group 1 had negative SPECT scans and were treated successfully with oral antibiotics and minimal soft tissue debridement. Three patients in Group 3 had negative SPECT scans and were treated successfully with antibiotics and limited debridement. Ten patients with positive SPECT scans were treated with a combination of antibiotics and aggressive surgical intervention. In conclusion, CT findings in the soft tissues offer little specificity in distinguishing soft tissue inflammation from osteomyelitis of the sternum.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone and Bones↗
PubMed2006

Follicular thyroid carcinoma: metastasis to the sternum, 13 years after total thyroidectomy.

Primary and metastatic malignancies of the sternum are uncommon. Secondary lesions to the sternum occur more commonly in patients with lung and breast cancer, and only a few cases of sternal metastasis arising from a follicular thyroid carcinoma have been reported in the literature. Rarely, metastases to the sternum present in the guise of primary sternal tumours may be treated surgically with that diagnosis in mind. We describe a case of a sternal mass treated by radical surgery, which ultimately proved to be a solitary metastasis from a follicular carcinoma of the thyroid, appearing 13 years after total thyroidectomy and radioactive iodine therapy. Late metastatic thyroid carcinoma to the sternum should be kept in mind in the differential diagnosis of sternal lesions. For patients with thyroid carcinoma and sternal metastasis, we recommend surgical resection of the metastasis, not only as a curative or palliative measure but also to maximise the effect of subsequent radioiodine treatment.

Adenocarcinoma, Follicular↗
PubMed2001

Gelatin sheet incorporating basic fibroblast growth factor enhances healing of devascularized sternum in diabetic rats.

BACKGROUND: Poor healing of the sternum often limits the use of bilateral internal thoracic arteries (BITAs) after coronary bypass surgery in diabetic patients. We have reported that a gelatin sheet that incorporates basic fibroblast growth factor (bFGF) accelerates sternal healing after BITA removal in normal rats. This study evaluated the effects of the above method for sternal healing in diabetic animals. METHODS AND RESULTS: Diabetic Wistar rats with blood glucose levels >400 mg/dL and body-weight loss >20 g were established by a single intravenous injection of streptozotocin (55 mg/kg). After median sternotomy and BITA removal, 16 diabetic rats received either a gelatin sheet that incorporated bFGF (100 microg/sheet) on the posterior table of the sternum (FGF group, n=9) or no gelatin sheet (control, n=7). Peristernal blood flow, as measured by a noncontact laser Doppler 4 weeks after surgery in the FGF group, recovered to the preoperative level (106+/-10% versus 82+/-9%, P<0.01), and marked angiogenesis was also observed around the sternum in the FGF group (30.5+/-3.2 versus 15.8+/-2.7 vessels/unit area, P<0.01). Deep sternal wound complications developed in 5 control rats but only in 1 rat in the FGF group (P<0.05). In the FGF group, histological examination showed improved sternal healing (excellent in 6 rats and slow/poor healing in 3). Bone mineral content as assessed by dual-energy x-ray absorptometry was greater in the FGF group (75.9+/-18.1 versus 48.9+/-10.7 mg, P<0.05). Bone mineral density of the sternum was similar between the 2 groups. CONCLUSIONS: A gelatin sheet that incorporates bFGF may offset sternal ischemia and accelerate sternal bone regeneration and healing, even in diabetic patients.

Administration, Topical↗
PubMed2002

Finite element analysis of stress around a sternum screw used to prevent sternal dehiscence after heart surgery.

The sternum screw has been proposed as a means of preventing sternal dehiscence, following heart surgery, by increasing the contact area between the wire used to close the median sternotomy and the surrounding bone; as a result, the contact stress is reduced. A finite element model was constructed of a cylindrical wire or screw passing through a block of sternum which consisted of cancellous bone sandwiched within a cortical shell. The thickness of the cortical shell and the material properties of bone were varied between reasonable values. The stress distribution in the sternum was calculated for each model when the wire was subjected to a tension (250 N) which would be required for six wires to withstand a strong cough (40 kPa). Results were validated by comparison with a simple analytical model in which the bone and wire were considered incompressible. They show that the screw reduces the contact stress to almost one-seventh of its value when wire is used alone. Contact stresses are especially high if the cortical shell is thin. The high stress in the bone around a screw falls off within a few millimetres. As a result, no problems are anticipated in placing six screws in each half-sternum so that the sternotomy may be closed with the usual six wires.

Bone Screws↗
PubMed2007

Insufficiency fracture of the sternum simulating myocardial infarction: case report and review of the literature.

Insufficiency fracture is a type of stress fracture that occurs when stress is applied to the bone with less than the normal elastic resistance, as in osteoporosis. Insufficiency fracture of the sternum is rare among all kinds of fractures. We describe two cases with insufficiency fractures of the sternum secondary to osteoporosis and thoracic kyphotic deformity. Both of the present cases, a 76-year-old woman and a 65-year-old woman, presented with severe anterior chest pain simulating myocardial infarction. However, cardiopulmonary examinations including chest radiographs, electrocardiograms, and laboratory tests were normal. Lateral radiographs of the sternum in both patients showed insufficiency fractures of the sternum. Conservative treatment with rib bandaging/bracing and analgesics relieved their symptoms. Clinical behavior, type of sternal insufficiency fractures, and mechanism of the fracture are reviewed from perusal of the literature. We emphasize that sternal insufficiency fracture should be considered in the differential diagnosis of acute chest pain in the elderly along with myocardial infarction or pulmonary embolism.

Aged↗
PubMed2003

[Treatment of defects of soft tissue and sternum, as postoperative complications of A-C bypass, case report].

Medial sternotomy is optimal approach for great number of heart surgery. Deep infection of sternum and mediastinis are very rear, but very dangerous complications followed by high rate of morbidity and mortality. Factors which can be responsible for these complications are numerous: post operation bleedings, surgery reinterventions, extended mechanical ventilation, liver chronic diseases, older age, diabetes, previous irradiation therapy, respiratory obstructions and use of steroids. Clinical signs for these complications are: red skin around the surgical wound, leaking, dehiscence, increased body temperature and instability of sternum. Early diagnosis, adequate antimicrobial therapy, and aggressive surgical and multidisciplinary approach in initial phase, are base for successful treatment. Surgical treatment most often assumes use of flaps. Our main objective in this work was to present treatment of defect of sternum and soft tissues, after triple aorto-coronary bypass. After the surgery patients got slack of sternum's ficsation and reficsation. With satisfactory respiratory function, corrections of defect was achieved by omentum and bipedicular myocutan flaps. (m. pectoralis major flap). There was no complications.

Aged↗
PubMed2005

Primary synovial sarcoma of the sternum: computed tomography and magnetic resonance imaging findings.

We report the computed tomography (CT) and magnetic resonance imaging (MRI) findings of a rare case of synovial sarcoma of the sternum in an 86-year-old man. CT demonstrated an inhomogenously enhanced soft-tissue-density mass of the sternum that destroyed bone cortex and protruded anteriorly. On MRI, the tumor showed a multinodular mass with internal septation and heterogeneous enhancement. These CT and MRI findings were nonspecific, but were similar to those of soft tissue synovial sarcomas. The tumor was more clearly demarcated by MRI than CT. This is the first report concerning the CT and MRI findings of synovial sarcoma of the sternum. Synovial sarcoma should be added to the gamut of primary malignant neoplasms of the sternum.

Aged↗
PubMedDate not supplied

Photon-deficient finding in sternum on bone scintigraphy in patients with malignant disease.

The sternum is known as a common site of bone metastasis in a variety of neoplasms. Sternal metastasis is usually visualized as hot spot on bone scintigraphy. However, photon deficiency in the sternum on bone scintigraphy is reported in few cases with malignancy. We undertook a retrospective analysis to clarify the clinical significance of photon deficiency in the sternum in 12 patients with malignancy. Twelve patients (five breast cancer, two multiple myeloma, one lung cancer, one renal cell cancer, one hepatocellular carcinoma, one malignant lymphoma, and one thyroid cancer) showing cold sternal metastasis on bone scintigraphy were identified among 9,430 patients in whom bone scintigraphy was performed. Except for two cases with pathologically confirmed sternal metastasis, all patients showed lytic change in the sternum on tomography or CT scan. Six cases of solitary sternal metastasis showed partial effect of systemic therapy (chemotherapy, humoral therapy, and radiation therapy) and surgical treatment. It is necessary to keep in mind that this type of lesion may occur as a manifestation of metastatic disease.

Adult↗
PubMed1988

[Extra-osseous and intra-osseous microvascularization of the sternum of the child].

The microvascularization of the sternum of the child has been studied by a method of India ink injection and by histology. Extra-osseous vasculature includes vascular pedicles and sternal vascular networks. Vascular anterior and posterior pedicles issue from internal mammary vessels. Sternal anterior and posterior networks are disposed on the faces of the sternum and are divided in a superficial one and a deep one; both are included in the perichondrium. In newborns and in young infants, vascular structures looking like baskets are affixed to the deep sternal network. It is unlikely that they intervene in the constitution of the adult pattern of the sternal vasculature. The early complete development of sternal networks contrasts with the existence of evolutive characteristics of the intra-osseous vasculature. Intra-osseous vasculature includes the cartilage canal vessels and the vessels of the ossification centers. Cartilage canals are provided with an axial artery, issued from the deep sternal network, which produces short capillaries which continue in peripheral sinuses. Cartilage canals permit the penetration of perichondral tissue deep in the cartilage of the developing sternum, allowing the formation of the ossification center. The ossification center is vascularized by centrifugal arteries, issued from the cartilage canal artery, and disposed in a radiant pattern. They continue, through a conical progressive dilatation, into a sinusoid network, which presents a convergent disposition towards the center of the ossification point. Vascular events precede ossification. Hematopoietic development is consecutive to the vascular events too. The slenderness of vascular pedicles contrasts in neonates with the wide development of the sinusoid network. Adipose tissue is rare in the bone marrow sternum of the child. Secondary evolution of the ossification center vasculature permits its connections with the deep sternal vascular network, with adjacent cartilage canals, and with adjacent ossification centers. Progressively, the number and the importance of the peripheral pedicles of the ossification centers increase. Thus, a multiple and centripetal vascular provision takes the place of the initial, unique, centrifugal one. These modifications correspond to the transition from the vascular pattern of an expanding structure (the ossification center) to the one which is adapted to the full expression of its hematopoietic function.

Adolescent↗