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Paediatric Anaesthesia Nov 2017Shamberger and Welch classify sternal malformations into four types: thoracic ectopia cordis, cervical ectopia cordis, thoraco-abdominal ectopia cordis, and cleft... (Review)
Review
Shamberger and Welch classify sternal malformations into four types: thoracic ectopia cordis, cervical ectopia cordis, thoraco-abdominal ectopia cordis, and cleft sternum. Cleft sternum is the most common subset, with a reported incidence of 1 in 50,000 to 100,000 live births, representing 0.15% of all anterior chest wall malformations. Acostello et al further classify cleft sternum into complete or partial (superior, medium, inferior) with a simple superior partial cleft sternum being by far the most common with an orthotopic heart, intact pericardium, and normal skin coverage. Associated anomalies with superior partial cleft sternum are rare, but can include cervicofacial hemangiomas, midline raphe from the tip of the cleft to the umbilicus, and PHACES (posterior fossa malformations, facial hemangiomas, arterial anomalies with coarctation of aorta, cardiac defects, eye abnormalities, sternal cleft, and supraumbilical raphe) syndrome. The more rare inferior partial clefts are associated with thoraco-abdominal ectopia cordis as part of the Pentalogy of Cantrell (omphalocele, anterior diaphragmatic hernia, sternal cleft, ectopia cordis, ventricular septal defect/left ventricular diverticulum). This review summarizes the current knowledge of all four types of sternal malformations, and provides guidance for optimal anesthetic and perioperative care of these children.
Topics: Adolescent; Anesthesia; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Sternum; Young Adult
PubMed: 29030926
DOI: 10.1111/pan.13253 -
Anatomia, Histologia, Embryologia Apr 2015The sternum is a frequently used anatomical site to obtain bone marrow for diagnostic and therapeutic purposes in equine medicine and surgery. For a safe and...
The sternum is a frequently used anatomical site to obtain bone marrow for diagnostic and therapeutic purposes in equine medicine and surgery. For a safe and reproducible aspiration of sternal bone marrow, a reliable anatomical description of the sternum is mandatory. However, the anatomical literature provides very heterogeneous information concerning the structure and number of sternebrae. Isolated sterna (horses of different ages) underwent clinical computed tomography, and single sternebrae were scanned by microcomputed tomography. Data sets were analysed in detail, the dimensions of each sternebra were determined, and correlations to the age and weight were generated. A uniform arrangement of seven sternebrae within the equine sternum was obtained, whereas the 6th and 7th sternebrae were fused in all sterna. The cranial sternebrae (sternebrae 1-3) had a lentiform shape with flattened lateral sides, while the caudal sternebrae (6 and 7) were flattened dorso-ventrally. In contrast, sternebrae 4 and 5 were spherical. The single sternebrae were well demarcated to the chondral sternum and showed two different zones. The periphery consisted of radiodense woven tissue, while in the centre the radiodense tissue was loosely arranged and contained large cavities with radiolucent tissue. A thin lamina (substantia corticalis) of <1 mm was arranged around the peripheral zone. There was no correlation between the body weight and the dimensions of the sternebrae, but there was a positive correlation to the age of the horses. The obtained data provide a sufficient basis to establish a standard nomenclature of the equine sternum.
Topics: Age Factors; Animals; Body Weight; Horses; Imaging, Three-Dimensional; Models, Anatomic; Sternum; X-Ray Microtomography
PubMed: 24712337
DOI: 10.1111/ahe.12114 -
The Annals of Thoracic Surgery Feb 2019Studies have confirmed that, for severe flail chest or sternal fractures and even multiple rib fractures, surgical treatment can effectively reduce hospital stay and...
Studies have confirmed that, for severe flail chest or sternal fractures and even multiple rib fractures, surgical treatment can effectively reduce hospital stay and relieve chest wall pain. However, fixation of multiple costal cartilage fractures in such a small area is a challenge if an internal fixator is simply placed directly on the sternum. This case report shares a method of simultaneous fixation of multiple costal cartilage and sternal fractures through a small incision, and it is also appropriate for multiple costal cartilage fractures without sternal fracture.
Topics: Costal Cartilage; Flail Chest; Fracture Fixation, Internal; Fractures, Bone; Fractures, Cartilage; Humans; Male; Middle Aged; Sternum
PubMed: 30081030
DOI: 10.1016/j.athoracsur.2018.06.044 -
F1000Research 2023The sternum exhibits unique anatomical variations with major clinical and forensic implications. This study is devoted to providing baseline epidemiological information... (Observational Study)
Observational Study
The sternum exhibits unique anatomical variations with major clinical and forensic implications. This study is devoted to providing baseline epidemiological information about the sternal foramen and variant xiphoid morphology in Ethiopia. Two extremely interesting and unusual variations of the sternal foramen are also discussed. This observational study was carried out using dried adult human sternum obtained from skeletal remains samples brought for medicolegal examination over a period of 4 years. A total of 94 dried adult human sternums (66 males (70.2%) and 28 females (29.8%)) were obtained with an age range of 21 to 57 years and a mean age at death of 38.383 ± 11.3480 years. Dried human sternum specimens were morphologically examined, and morphometric parameters were recorded and photographed. A sternal foramen was found in 18 specimens (19.1%); 17 were male and one was female. A single sternal foramen was observed in 83.3% (n=15/18) of the sternal bodies and 11.1% (n=2/18) of the xiphoid processes (both males). In addition, a double sternal foramen was observed in a single male specimen on the mesosternum and xiphoid process. The most common sternal foramen site was at the fifth costochondral junction level. The xiphoid process was present in 77 samples and ended as a single process in 83.1% (n=64/77) of samples. In 15.6% (n=12/77) of the samples, the xiphoid process was bifurcated and trifurcated in a single male (1.3%) specimen. The sternal foramen and variation in xiphoid morphology are common anatomical variations in Ethiopia. The findings of the current study highlight the necessity of strict precautionary measures during sternal procedures in this study population. In addition, such incidental findings during radiologic and autopsy procedures should be properly evaluated to avoid misdiagnosis and misinterpretation of such findings as traumatic or pathologic conditions.
Topics: Humans; Sternum; Male; Female; Ethiopia; Adult; Middle Aged; Young Adult; Anatomic Variation; Xiphoid Bone
PubMed: 38845617
DOI: 10.12688/f1000research.133151.1 -
Archives D'anatomie, D'histologie Et... 1988The 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... (Review)
Review
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.
Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Microcirculation; Osteogenesis; Sternum
PubMed: 3078484
DOI: No ID Found -
Current Opinion in Pediatrics Jun 2013Pectus carinatum has been termed the undertreated chest wall deformity. Recent advances in patient evaluation and management, including the development of nonoperative... (Review)
Review
PURPOSE OF REVIEW
Pectus carinatum has been termed the undertreated chest wall deformity. Recent advances in patient evaluation and management, including the development of nonoperative bracing protocols, have improved the care of children with this condition.
RECENT FINDINGS
Recent evidence confirms that children with pectus carinatum have a disturbed body image and a reduced quality of life. Treatment has been shown to improve the psychosocial outcome of these patients.
SUMMARY
Patients with pectus carinatum are at risk for a disturbed body image and reduced quality of life. Until recently, treatment required surgical reconstruction. A growing body of literature, however, now supports the use of orthotic bracing as a nonoperative alternative in select patients. This article reviews the current literature and describes the evaluation and management of children with pectus carinatum deformity.
Topics: Bone Diseases, Developmental; Braces; Humans; Radiography; Sternum; Terminology as Topic; Thoracic Wall
PubMed: 23657247
DOI: 10.1097/MOP.0b013e3283604088 -
Emergency Medicine Journal : EMJ Nov 2003Sternal fracture is poorly characterised in children. The purpose of this study was to gain insight into the mechanism, radiological characteristics, and accompanying...
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.
Topics: Accidental Falls; Child; Child, Preschool; Female; Fractures, Bone; Humans; Male; Radiography; Retrospective Studies; Sternum
PubMed: 14623836
DOI: 10.1136/emj.20.6.518 -
Journal of Morphology Nov 2014Age and sex-related variations in sternum morphology may affect the thoracic injury tolerance. Male and female sternum size and shape variation was characterized for...
Age and sex-related variations in sternum morphology may affect the thoracic injury tolerance. Male and female sternum size and shape variation was characterized for ages 0-100 from landmarks collected from 330 computed tomography scans. Homologous landmarks were analyzed using Procrustes superimposition to produce age and sex-specific functions of 3D-sternum morphology representing the combined size and shape variation and the isolated shape variation. Significant changes in the combined size and shape variation and isolated shape variation of the sternum were found to occur with age in both sexes. Sternal size increased from birth through age 30 and retained a similar size for ages 30-100. The manubrium expanded laterally from birth through age 30, becoming wider in relation to the sternal body. In infancy, the manubrium was 1.1-1.2 times the width of the sternal body and this width ratio increased to 1.6-1.8 for adults. The manubrium transformed from a circular shape in infancy to an oval shape in early childhood. The distal sternal body became wider in relation to the proximal sternal body from birth through age 30 and retained this characteristic throughout adulthood. The most dramatic changes in sternum morphology occur in childhood and young adulthood when the sternum is undergoing ossification. The lesser degree of ossification in the pediatric sternum may be partly responsible for the prevalence of thoracic organ injuries as opposed to thoracic skeletal injuries in pediatrics. Sternum fractures make up a larger portion of thoracic injury patterns in adults with fully ossified sternums. The lack of substantial size or shape changes in the sternum from age 30-100 suggests that the increased incidence of sternal fracture seen in the elderly may be due to cortical thickness or bone mineral density changes in the sternum as opposed to morphological changes.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Anthropometry; Bone Density; Child; Child, Preschool; Computer-Aided Design; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Osteogenesis; Radiographic Image Enhancement; Reference Values; Regression Analysis; Reproducibility of Results; Sex Factors; Sternum; Tomography, X-Ray Computed; Young Adult
PubMed: 24935890
DOI: 10.1002/jmor.20302 -
The Journal of Bone and Joint Surgery.... Sep 1985Injuries to the sternum and thoracic cage are relatively frequent in this age of motor-vehicle accidents, high-speed sports activities, and industrial injuries, yet...
Injuries to the sternum and thoracic cage are relatively frequent in this age of motor-vehicle accidents, high-speed sports activities, and industrial injuries, yet non-union of a fracture of the sternum is exceptionally rare. Sternotomy is commonly performed in cardiothoracic surgery, and the sternum is usually divided vertically or transversely, but non-union of the sternal cut is rare. Fracture of the sternum in a child is especially rare.
Topics: Adult; Aged; Bone Plates; Bone Screws; Female; Flail Chest; Fractures, Ununited; Humans; Male; Middle Aged; Radiography; Sternum
PubMed: 4030828
DOI: No ID Found -
AJR. American Journal of Roentgenology Jul 1986
Topics: Humans; Sternum; Tomography, X-Ray Computed
PubMed: 3487234
DOI: 10.2214/ajr.147.1.72