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PubMed1991

Cranio-caudal movement of the sternum on induction of anaesthesia.

The cranio-caudal movement of the sternum was studied by the technique of video magnification during induction of anaesthesia with thiopentone 2-4 mg kg-1 i.v. in 20 patients. Anaesthesia produced no consistent change in end-expiratory position of the sternum; there was a range of movement from 3.1 mm cephalad to 5.4 mm caudad. There was a significant relationship between movement and degree of obesity of the patient (P less than 0.01), with the sternum tending to caudal movement in the obese patient.

Anesthesia, Intravenous↗
PubMed1981

Formation and maturation of the human sternum. I. Fetal period.

In continuing attempts to develop reliable morphologic, x-ray, and gross criteria for age estimation utilizing the sternum and costal cartilages, it became necessary to study the fetal development of the sternum. While there is a wide variability in the number and configuration of the ossification centers of the developing sternum, several basic developmental patterns emerge. These are illustrated and compared with Ashley's classic work. In general, ossification begins in the manubrium and progresses to the mesosternal (body) segments, developing from rostral to caudal. The more or less final sternal pattern is not found until a number of years after birth. The wide variation in fetal sternal development would seem to preclude its use for satisfactory gestational age estimation; it is clearly less valuable than other morphologic criteria already available. However, an understanding of fetal development does greatly assist in understanding the pre- and postpubertal sternal patterns.

Female↗
PubMed1999

Internal fixation of the sternum in median sternotomy dehiscence.

Sternal dehiscence may be defined as separation of the bony sternum and manubrium following median sternotomy. It may occur at any time postoperatively and has various etiologies. Restoration of sternal integrity in sternal dehiscence is a challenging problem, particularly when associated with deep-seated infection. This report reviews a single-stage technique that virtually eliminates the infected sternotomy wound and provides anatomic reduction and stabilization of the sternum. Complete debridement of infected and/or nonviable soft tissue, bone, and cartilage is followed by pulse irrigation. Parallel stainless steel mandibular reconstruction plates are then placed on each side of the remaining sternum and wired together. One or more transmanubrial compression plates may be added. Bilateral pectoralis major musculocutaneous flap advancement and primary skin closure is performed over two to three closed suction drains. From January of 1994 to July of 1996, this technique was used by the same surgeon in 26 male and 4 female patients aged 43 to 78 years (mean = 61). Indications for the operation were sternal dehiscence with infection (osteomyelitis and/or mediastinitis) in 14 patients and sternal dehiscence without infection in 16 patients. All patients survived to discharge with mean time on the ventilator, intensive care unit length of stay, and postoperative length of stay of 0.7, 2, and 8 days, respectively. Choice and duration of antibiotics were based on culture results and operative findings. Subsequent hardware removal was necessary in one patient for hardware loosening and three patients for late periplate infection. A closed wound was eventually achieved in all 30 patients, and sternal stability was restored in 29 patients. In the management of sternal dehiscence, the described technique of internal fixation can provide anatomic sternal reduction and stabilization, elimination of infection, and wound closure in a single-stage operation. Successful outcomes were achieved despite the presence of severe infection.

Adult↗
PubMed2005

The role of the sternum, costosternal articulations, intervertebral disc, and facets in thoracic sagittal plane biomechanics: a comparison of three different sequences of surgical release.

STUDY DESIGN: Eighteen human torsos were used in three experiments (A, B, and C) to determine the changes in sagittal motion due to three different sequences of three surgical releases. OBJECTIVES: To investigate the relative effects of releasing the intervertebral disc, the costosternal joint, the sternum, and the facet joints on sagittal thoracic motion and the consequences of altering the sequence of the releases. SUMMARY OF BACKGROUND DATA: The biomechanics of the thoracic spine are different from the cervical and lumbar spine particularly due to the ribs and sternum, which contribute to stability and control motion. The role of the sternum and costosternal articulation in the biomechanics of thoracic sagittal motion has not been well studied. The effects of releasing each of these structures, whether alone or with discectomy and/or facetectomy, is potentially relevant in the surgical correction of thoracic deformities, such as severe kyphosis, and in the biomechanics of thoracic fracture. METHODS: In Experiment A, the release sequence was back to front: total facetectomy (T4-T8), then radical discectomy (T4-T8), then costosternal release, then sternal osteotomy. In Experiment B, the release sequence was front to back: sternal osteotomy, then costosternal release, then radical discectomy, and finally total facetectomy. In Experiment C, the release sequence was: radical discectomy, then sternal osteotomy, then costosternal release, then total facetectomy. The different sequences allowed separate analysis of each component and the synergistic patterns. In each of the three experiments, the torso was flexed then extended each time by an applied force (25 N) before and after each release. The extent of flexion and the extent of extension were measured each time and compared with the intact condition, after each release. RESULTS: The results obtained for sternal osteotomy were combined with the results obtained for costosternal release to give "sternal release." Radical discectomy provided the greatest increase (P < 0.05) in range of motion (ROM) compared with the other two single releases, no matter what the sequence. For paired release combinations, the radical discectomy and sternal release (as in Experiments B and C) provided a significant (P < 0.05) increase in total sagittal ROM compared with the combination of radical discectomy and total facetectomy (Experiment A). In Experiment A, sternal release accounted for 42% of the total sagittal ROM compared with only 26% related to the total facetectomy (Experiment B). In general, all of the releases allowed more extension than flexion. CONCLUSIONS: Sagittal plane motion in the thoracic spine is influenced by all three structures tested in this experiment. Overall, the radical discectomy provides the greatest increase in total ROM and in extension compared with the other two releases. The second most influential release is the combination of sternal osteotomy plus costosternal release (i.e., sternal release), particularly in extension (correction of kyphosis). When two releases are done in sequence, radical discectomy plus sternal release provides the greatest increase in total ROM and in extension. Overall, total facetectomy is the least effective release. These data have relevance for surgical strategies in the correction of thoracic kyphosis or lordosis and suggest a potential role for sternal osteotomy and costosternal release in severe and rigid upper thoracic kyphosis.

Aged↗
PubMed2006

Sternum insufficiency fracture presenting as acute chest pain: a case report and review of the literature.

The spine, pelvic bones and long bones of the lower extremities are common sites for insufficiency fractures. Cases of sternum insufficiency fractures have been rarely reported in an elderly patient. Insufficiency fracture tends to occur in bones with decreased mechanical strength. It tends to occur in elderly patients, especially in postmenopausal women, with underlying diseases. We describe a case of sternum insufficiency fracture in a patient with rheumatoid arthritis and systemic lupus erythematosus on long-term corticosteroid therapy diagnosed in an emergency setting. Sternum insufficiency fracture is a rare cause of chest pain. This case serves to remind the emergency physician to remain vigilant for other noncardiac and nontraumatic causes of chest pain. If diagnosed accurately, these patients can be discharged and treated as outpatients.

Adrenal Cortex Hormones↗
PubMed1992

Comparative structure and morphology of the goat sternum in West African dwarf and Danish Landrace breeds.

The structure and morphology of the sternum from 33 West African dwarf (WAD) and sixteen Danish Landrace breed goats were studied radiographically. In young kids of the Danish Landrace breed (DL), the number of sternal elements (Sternebrae) was six or seven with the fifth or the last but one being double in some animals due to bilateral bodies. All the sternal elements in the WAD breed appeared to have each a single locus of ossification and the number of sternal elements varied between 5, 6 or 7 at birth. In those goats with 5 or 6 sternal segments, bilateral indentations were observed on the left and right side on either the last or the last two segments. These indentations were considered to indicate a prenatal cranial coalescence of the last segments leading to the reduced number of sternebra. The structure and morphology of the sternum in neonatal kids for the two breeds appears to be basically different. 8 sternal and 5 asternal ribs were observed in animals of both breeds. The cartilaginous attachments of the ribs on the sternal segments were variable. A floating rib was also observed in one of the WAD goats. The comparative structure and morphology of other ruminant sternum is also discussed.

Animals↗
PubMed2003

Fracture of the sternum in children.

OBJECTIVE: Sternal fracture is poorly characterised in children. The purpose of this study was to gain insight into the mechanism, radiological characteristics, and accompanying injuries of sternal fracture in children. METHODS: The study was retrospective. The records of all children who underwent plain radiography of the sternum, or computed tomography of the thorax after trauma, over a 40 month period in our paediatric hospital were reviewed for evidence of sternal fracture. RESULTS: 12 of 33 children identified had radiological evidence of sternal fracture. The age range of children with fractures was 5 to 12 years. Eleven children had fracture of the anterior cortex of the first or second sternebra of the body of the sternum. One child had fracture through the manubriosternal joint with posterior displacement of the body. Seven fractures resulted from direct blows to the anterior chest, five fractures resulted from hyperflexion injury of the thoracic spine. None were the result of motor vehicle crash. All fractures were isolated injuries. CONCLUSIONS: Sternal fracture is uncommon in children. Injury may result from direct or indirect violence. The child's sternum is commonly fractured by more minor blunt trauma than generally recognised in the literature. All patients with sternal fracture after indirect violence should have careful examination of the spine. Patients with undisplaced anterior cortical fracture without other injury may be safely discharged from the emergency department.

Accidental Falls↗
PubMed1993

Conversion of bone marrow in the humerus, sternum, and clavicle: changes with age on MR images.

To study the normal conversion of bone marrow in the humerus, sternum, and clavicle, 101 T1-weighted magnetic resonance (MR) studies obtained in 91 patients aged 2 days to 37 years were retrospectively evaluated. Conversion from hypointense (red) to hyperintense (yellow) bone marrow was assessed by comparison of signal intensity of the bone marrow with that of muscle and fat. Conversion began in the proximal humeral epiphysis (in 16 of 21 adequate studies [76%]), humeral diaphysis (17 of 30 adequate studies [57%]), and distal metaphysis (16 of 25 adequate studies [64%]) before age 1 year and was nearly complete in these regions (20 of 22 adequate studies [91%], 20 of 21 adequate studies [95%], and five of seven adequate studies [71%]) in examinations of children aged 1-5 years. In the proximal humeral metaphysis, conversion was seen in 21 of 22 adequate studies (95%) in children aged 1-5 years and was nearly complete in all by age 20 years. Conversion began in the sternum (six of six studies [100%] in children aged 6-10 years) and clavicle (six of eight studies [75%] in children aged 6-10 years) before age 11 years but was never complete. Bone marrow conversion in the humerus, sternum, and clavicle follows a well-defined pattern and is depicted earlier by MR imaging than one would expect on the basis of histologic data.

Adolescent↗
PubMed1991

Spontaneous fibro-osseous proliferative lesions in the sternums and femurs of B6C3F1 mice.

Bone morphology associated with fibro-osseous proliferation in the femurs and sternums of 98 female B6C3F1 mice were compared morphologically and quantitatively to femurs and sternums from 100 male B6C3F1 and 79 CF1 mice (48 female and 31 male). In addition, sternal samples from five B6C3F1 mice per sex were collected and processed for electron microscopy. Fibro-osseous proliferation was present in female B6C3F1 mice, but not male B6C3F1 or female CF1 mice. In female B6C3F1 mice at 32 weeks of age, the marrow spaces in the region of the proximal and distal epiphyseal plate were lined by large osteoblasts and had large vascularized centers. At 58 weeks, metaphyseal fibrovascular proliferative areas containing multinucleated cells and new cancellous bone delineating the lesion were seen. At 84 weeks, fibro-osseous tissue occupied the outer third of the sternal marrow cavity and by 110 weeks, more than two thirds of the marrow cavity. Fibro-osseous proliferation was present in 100 and 94% of the examined sternums and femurs, respectively, of female B6C3F1 mice at 110 weeks of age, but not in male B6C3F1 or female CF1 mice. Ultrastructural examination of the sternal changes at 110 weeks showed numerous osteoblasts, irregular bony spicules, and fibrocyte-like cells. By morphometry, the normal marrow cavity in B6C3F1 females occupied 35% of a longitudinal section of the whole sternebra compared with 70% and 75% of the whole sternebra in B6C3F1 males and CF1 female, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed2002

Pictorial review: MRI of the sternum and sternoclavicular joints.

The sternum and sternoclavicular joints are difficult to evaluate with plain radiographs. The value of CT in assessing lesions of the sternum and sternoclavicular joints has been well documented, but the potential role of MRI has not been emphasized. We present the MRI techniques, normal appearances and a spectrum of abnormalities, and emphasize the role of MRI as a useful radiological investigation for the sternum and sternoclavicular joints.

Bacterial Infections↗
PubMed1993

Radiologic abnormalities of the sternum in Turner's syndrome.

Various skeletal abnormalities, including chest deformity, have been reported with Turner's syndrome. We report radiologic findings of the sternum on lateral chest roentgenograms in 15 children and adolescents with Turner's syndrome, whose ages ranged between 2 weeks and 20 years. Eight had associated congenital heart disease (CHD). Twelve patients (80 percent) had various sternal abnormalities; 5 had short sternum, 3 had premature fusion of the manubrio-sternal junction, and 4 had premature fusion of the mesosternum. Five had decreased ratio of sternal body to manubrium. Three patients had two ossification centers of the manubrium. Four patients had bowing of the mesosternum; three of these had mild pectus excavatum also. In this series, children with and without CHD had similar sternal abnormalities. Although not pathognomonic, sternal abnormalities on a lateral chest roentgenogram are common skeletal abnormalities associated with Turner's syndrome and are independent of associated CHD. In our series of 15 patients, 10 had monosomy (45,X) on blood karyotype; 7 of them had associated CHD. This is the first systematic analysis of radiologic abnormalities of the sternum in Turner's syndrome and includes findings not previously reported.

Adolescent↗
PubMed1983

Computed tomography of the normal sternum.

The normal CT anatomy of the sternum was studied in 35 patients. In addition to the normal appearance of the sternum, normal variants that may mimic disease were often noted. In the manubrium, part of the posterior cortical margin was unsharp and irregular in 34 of 35 patients. Part of the anterior cortical margin was indistinct in 20 of the 35 patients. Angulation of the CT gantry to a position more nearly perpendicular to the manubrium improved the definition of the cortical margins. The body of the sternum was ovoid to rectangular and usually had sharp cortical margins. Sections through the manubriosternal joint and xyphoid often demonstrated irregular mottled calcifications and indistinct margins again simulating bony lesions. The rib insertions, sternal clavicular joints, and adjacent soft-tissue appearance also were evaluated.

Adolescent↗
PubMed2000

Cleft sternum and sternal foramen.

Cleft sternum is a rare congenital defect of the anterior chest wall and is the result of a failed midline fusion of the sternum. Depending on the degree of separation, there are complete and incomplete forms. Its clinical significance is that it leaves the heart and great vessels unprotected. Association with craniofacial hemangiomas and omphalocele is common. Prenatal diagnosis by ultrasonography is possible. Surgical correction should be performed during the neonatal period when the direct suturing of the sternal halves is possible and the thorax can accommodate the thoracic viscera. At an older age, surgical repair is feasible, but it may require additional measures, such as sliding chondrotomies of the adjacent costal cartilages and notching of the sternal bars, to facilitate the approximation. Lung herniation at the base of the neck should be corrected by uniting the cervical muscles. The first postoperative day is the most critical because of acute reduction of the mediastinal space. Long-term results are satisfactory. Sternal foramen is a congenital oval defect at the lower third of the sternum that is asymptomatic and could be detected by CT scanning. The awareness of the anomaly is important in acupuncture practice because of the danger of heart damage.

Abnormalities, Multiple↗
PubMed1976

Total excision of the sternum and thoracic pedicle transposition of the greater omentum; useful strategems in managing severe mediastinal infection following open heart surgery.

Mediastinal sepsis following open heart surgery is a significant cause of death. Open drainage of the mediastinumalone was employed originally in management of this problem. More recently, debridement, drainage, and reclosure have been used. Various irrigation solutions, such as antibiotics and Betadine, have been advocated to control severe mediastinal sepsis. Three principles of management in patients unresponsiveness to the above techniques have proved successful in two patients with life-threatening mediastinal sepsis: (1) radical, complete excision of the sternum and adjacent costal cartilages; (2) transposition of the greater omentum on a vascular pedicle to the mediastinum; and (3) primary closure with full-thickness rotational skin flaps. The radical excision of the sternum removes residual foci of sepsis in cartilage and sternal bone marrow. The transposition of the omentum provides a highly vascular, rapidly granulating covering for the contaminated great vessels and hase been successfully to prevent recurrence of suture line bleeding of an exposed ascending aortic anastomosis site. Primary closure of the wound with full-thickness skin flaps provides a suprisingly satisfactory covering for the heart. Preoperative and postoperative measurements of ventilatory mechanics have shown relatively small ventilatory impairment after the alteration of the thoracic cage imposed by excision of the sternum. Two patients have returned to active lives. A treatment failure probably due to incomplete adherence to these guidelines also is presented.

Adult↗
PubMed2000

[A method for the surgical treatment of patients with chronic postoperative osteomyelitis of the sternum].

The authors share their experiences with diagnosing and surgical treatment of chronic postoperative osteomyelitis of sternum developed in 36 patients after operations on the heart, lungs and organs of mediastinum. The purulent process can be liquidated in all the patients due to performing saving resection of the sternum and plasty of the bone defect with local tissues, application of a gauze-cotton roll pressing the subcutaneous fat into the bone defects formed after treatment of the affected portions of the sternum, administration of antibiotics according to sensitivity of the microflora.

Adult↗
PubMedDate not supplied

Pediatric osteoblastoma of the sternum: a new surgical technique for reconstruction after removal: case report and review of the literature.

Benign osteoblastoma is a rare tumor of bone that has been reported in a variety of skeletal locations. A case of an isolated benign osteoblastoma in the sternum of an 11-year-old boy is described. In the chest wall, osteoblastoma has been reported in the ribs, and rarely in the sternum. To the authors' knowledge, this is the first report of an isolated sternal osteoblastoma in a child presented in the literature. The clinical and radiologic presentation of osteoblastoma is discussed, as well as an approach for reconstruction of the sternal defect following removal of the tumor. Experience with sternal reconstruction in the pediatric population is limited. This case demonstrates that osteoblastoma of the sternum can be successfully treated with wide resection and that sternal defect reconstruction can be accomplished successfully in a child.

Biocompatible Materials↗
PubMed1992

[Emergency diagnosis of sternum fracture with ultrasound].

Fractures of the sternum often are not discernable on X-rays. The standard lateral X-ray of the sternum may allow the diagnosis. The aim of this study was to find out whether sternal fractures can be visualized by ultrasound. The flat, plane and broad bone provides an ideal rest for a linear scanner; the one used in our study had 5 MHz. We show that sternal fractures can easily be diagnosed by means of ultrasound, and because of an interruption of the cortical reflex, possibly better than on radiographs. We also wanted to show whether sonography, which is in widespread use for the diagnosis of blunt abdominal trauma, can also be used in an emergency situation of blunt thoracic injury (e.g. seat belt injury). In 16 cases of fractures of the sternum already diagnosed by X-ray, an examiner unacquainted with the X-ray results was able to locate and diagnose all fractures by ultrasound within 1 min.

Accidents, Traffic↗
PubMed1992

Position of heart in relation to sternum and nipple line at various ages.

Frontal X-ray pictures of 210 healthy children from birth to twelve years of age with radio-opaque markers at sternal ends and both nipples were reviewed. The position of centre of cardiac silhouette was correlated with sternal areas and internipple line. The heart was found to descend with age, its centre lying beneath mid-sternum during first six months of life and beneath lower sternum after infancy (p less than 0.001). The position did not vary with age in relation to internipple line (p greater than 0.05). In 77.6% of all children, it was below the internipple line and in 22.4% above or at the internipple line. Because of the erratic relationship of cardiac centre with internipple line, the latter should not be considered a landmark for cardiac position. External cardiac massage should be applied in relation to sternum and at different locations according to the age. Sites for optimal compression have been suggested. No sexual dimorphism was observed.

Anthropometry↗