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Journal articles on the topic 'Sternum'
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1
Das A. "Anatomical Variation of Sternal Angle and Body: a Cross sectional study." Journal of Sylhet Women’s Medical College 14, Number 2 (July 1, 2024): 48–51. http://dx.doi.org/10.47648/jswmc2024v14-02-103.
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Background: The sternum is one of the important skeletal components ofthoracic case that frequently has congenital defects, and researchers routinely use variances to ascertain an individual's age and sex. Additionally, it helps the physician with biopsy procedures as well as therapy. The objective of this study was to evaluate the morphological characteristics of sternal body and sternal angle in both sexes. Method: This cross-sectional stuywas carried out at the Department of Anatomy, Sylhet MAG Osmani Medical College. For this purpose, 100 dried ossified sternums of unknown sex had been collected. The sample was collected in compliance with the inclusion and exclusion criteria. Discriminant function analysis was used to determine the sex of each sternum (DFA). Study variables were the maximum length of sternal body, maximum breadth of sternal body, thickness of the sternal body and sternal angle. Variables were measured using a vernier caliper and documented in a pre-designed data sheet. Result: The mean length of the body of sternum was 93.84±23.31 mm in male and 82.84±14.8 mm in female. The mean width of the body of the sternum was 35.3±10.83 mm in male and 29.22±9.65 mm in female. The thickness of the body of the sternum is 19.86±9.91 mm in males and 16.12±7.39 mm in females. Analysis revealed that length of body sternum, width of body of sternum and thickness of body of sternum were higher in male than female which was statistically significant (p<0.05).The mean angle of sternum was 148.29±8.240 degrees in males and 149.32±9.690degrees in females, respectively. The difference was statistically not significant (p<0.05). Conclusion: In females, the maximum sternal length, maximum sternal breadth, and maximum sternal thickness were all significantly lower.
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Lema, Alemayehu Shiferaw. "Anatomical variations of the sternum: sternal foramen and variant xiphoid morphology in dried adult human sternum in Ethiopia." F1000Research 12 (August 7, 2023): 934. http://dx.doi.org/10.12688/f1000research.133151.1.
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Background: 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. Methods: 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. Results: 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. Conclusions: 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.
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Chakravarthi, Kosuri Kalyan, Siddaraju K. S., Nelluri Venumadhav, and Sangeeta Atamaram Bali. "Anatomical and congenital variations of human dry sternum bone: its embryogenesis and clinical implications." International Journal of Research in Medical Sciences 6, no. 1 (December 23, 2017): 300. http://dx.doi.org/10.18203/2320-6012.ijrms20175738.
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Background: The sternum is one of the skeleton parts with frequently detected variation in cross-sectional images or autopsy series. The anatomical or congenital variations of the sternum in the anterior chest wall may involve malignancies, injuries or severe traumas. The aim of the study was undertaken to evaluate the incidence of anatomical and congenital variations of human dry sternum bones.Methods: This study was carried out on 120 dry human sternum bones irrespective of age and sex at Varun Arjun medical college- Banthra, UP, KMCT Medical College, Manassery-Calicut and Melaka Manipal Medical College-Manipal. All the sternum bones were macroscopically inspected for the anatomical and congenital variations of human dry sternum bones. Photographs of the anatomical and congenital variations were taken for proper documentation.Results: Complete sternal foramina in the body of the sternum were noted in 9 bones (7.5%), with an average vertical diameter of 17mm and transverse diameter of 16mm (The highest vertical diameter of 19mm and transverse diameter of 17mm was noted); Incomplete sternal foramina in the body of the sternum were noted in 4 bones (3.3%);Complete sternal foramina in the xiphoid process of the sternum were noted in 7 bones (5.8%) with an average vertical diameter of 6mm and transverse diameter of 8mm; Unusual complete sternal foramina in the body and incomplete sternal foramina in the xiphoid process of the sternum were noted in 8 bones (6.6%); Very rare longer xiphoid process (7.3 cm) with complete sternal foramina was noted in 7 bone (5.8%); Unusual Longer xiphoid process with an average length of 6.7cm with sharp bifid ends was noted in 8 bones (6.6%).Conclusions: The knowledge of existence of anatomical variants and congenital foramina of sternum and xiphoid process found in our study is essential, especially for bone marrow sampling, radiology (X - ray, CT, MRI, and USG) reporting, pathology autopsy and forensic medicine post-mortem reporting and patoacupuncture practice to avoid complications during various surgical procedures.
4
Duman, Zihni M., Barış Timur, Çağdaş Topel, and Timuçin Aksu. "Clinical Use of Tailored Computed Tomography to Prevent Poststernotomy Dehiscence." Thoracic and Cardiovascular Surgeon 70, no. 01 (December 31, 2021): 072–76. http://dx.doi.org/10.1055/s-0041-1736243.
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Abstract Background Morphological and tissue density analysis of the sternum can be performed in the preoperative computed tomography (CT). The purpose of this study was to analyze morphology and tissue density of sternum in CT and effect for comparison sternal instability. Methods Patients with sternal instability (n = 61) and sternal stability (n = 66) were enrolled in this study. All of the patients were studied using same thorax CT procedure. All the measurements were performed by one specific cardiovascular radiologist. The Hounsfield units (HUs) were measured in axial sections of the sternum trabecular bone. Results Sternal instability group mean HU was 75.36 ± 13.19 and sternal stability group HU was 90.24 ± 12.16 (p < 0.000). HU is the statically significant predictor of sternal instability. Conclusion Our study showed a significant correlation between the mean HU value of sternum and sternal instability. We think that it is important to evaluate the existing thorax CT while performing preoperative risk analysis for sternal dehiscence.
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De Troyer, A., and T. A. Wilson. "Sternum dependence of rib displacement during breathing." Journal of Applied Physiology 75, no. 1 (July 1, 1993): 334–40. http://dx.doi.org/10.1152/jappl.1993.75.1.334.
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The parasternal intercostals are the primary determinant of the inspiratory cranial displacement of the ribs in the dog. When they contract, however, these muscles also cause a caudal displacement of the sternum, presumably an expiratory motion. The present studies were designed to assess the effects of this sternal displacement on the cranial displacement of the ribs and on lung volume. Twelve supine anesthetized animals were studied. We first measured, in four paralyzed animals, the displacement of the ribs and sternum produced by known external forces applied to the ribs, the sternum, or both simultaneously. From these measurements, the elastic coupling between the ribs and sternum was determined. We then studied, in eight animals, the effect of sternal motion on rib motion and tidal volume during spontaneous breathing. Rib and sternal displacements and tidal volume were measured first with the sternum free to move caudally during inspiration and then with the sternum constrained to prevent caudal motion. Preventing the sternum from moving caudally caused a 24% increase in the inspiratory cranial displacement of the ribs; this increased displacement of the ribs agreed well with the elastic coupling between the sternum and the ribs as determined from the force-displacement observations. Tidal volume, however, remained unchanged. These observations indicate that the caudal displacement of the sternum produced by the parasternal intercostals reduces the cranial displacement of the ribs but probably increases the lateral expansion of the rib cage.
6
Sotnikov, A. V., V. M. Melnikov, R. V. Almadi, and G. N. Gorbunov. "AN APPROACH FOR MEDIASTINITIS PREVENTIONIN PATIENTS FOLLOWING CARDIAC SURGERY." HERALD of North-Western State Medical University named after I.I. Mechnikov 7, no. 4 (December 15, 2015): 38–42. http://dx.doi.org/10.17816/mechnikov20157438-42.
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The aim of this study was to reduce incidence of sternal deep wound infection (DWI) in patients following cardiac surgery. An experience of cardiac surgery by sternotomy access in 429 consecutive patients was presented. Perioperative intravenous injections of cefazolin were used in 225 patients (control group). Combination of perioperative intravenous injections with local retrosternal irrigation of cefazolin before sternum closure was used in 204 patients (study group). In control group sternal DWI occurred in 10 patients (4.4%), and in 4 patients a resternotomy sanation required. There were no deaths in this group due to infection or sepsis. In follow-up period (3 years), instability of sternum occurred in 3 patients (1.3%), and in 1 (0.4%) sternum reosteosynthesis required. In studied group the sternal DWI did not occur (p<0.01). Sternum instability and/or indications for sternum reosteosynthesis were not determined in follow-up period (2 years). It was concluded, that combination of intravenous and local usage of cefazolin in cardiac surgery patients is a simple and effective approach to prevent sternal DWI. Application of this method significantly (p<0.01) reduces the incidence rate of mediastinitis.
7
Nasmi, C., A. Radi, R. Abilkassem, and A. Agadr. "Tuberculous Osteomyelitis Presenting as a Sternal Mass in Paediatric Patient: A Case Report." Asian Journal of Pediatric Research 13, no. 3 (August 21, 2023): 18–23. http://dx.doi.org/10.9734/ajpr/2023/v13i3273.
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Background: Sternal tuberculosis is an uncommon form of extrapulmonary tuberculosis and it can be a diagnostic challenge for pediatricians.
Case Presentation: We report the case of a young 14-year-old boy, who had a gradually increasing swelling of the sternum over the past 2 months preceded by weight loss, asthenia and night sweats. Radiological, histological, and microbiological investigations confirmed it as a case of sternal tuberculosis (TB). He was managed with surgical debridement during the sternal biopsy and quadruple antituberculosis therapy with good response.
Discussion: Tuberculosis (TB) of sternum is one of the rarest forms of skeletal tuberculosis. The incidence of sternal tuberculosis has been calculated to be <1.5% amongst osteo-articular tuberculosis, with very few cases reported in infants. The diagnosis is based on histological and bacteriologic arguments.
Conclusion: Tuberculous osteomyelitis of the sternum is a rare finding in children. Our aim is to increase awareness around atypical presentations and the uncommon involvement of the sternum in musculoskeletal tuberculosis.
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Feneck, Eleanor M., Sorrel R. B. Bickley, and Malcolm P. O. Logan. "Embryonic Development of the Avian Sternum and Its Morphological Adaptations for Optimizing Locomotion." Diversity 13, no. 10 (September 29, 2021): 481. http://dx.doi.org/10.3390/d13100481.
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The sternum is part of the forelimb appendicular skeleton found in most terrestrial vertebrates and has become adapted across tetrapods for distinctive modes of locomotion. We review the regulatory mechanisms underlying sternum and forelimb development and discuss the possible gene expression modulation that could be responsible for the sternal adaptations and associated reduction in the forelimb programme found in flightless birds. In three phylogenetically divergent vertebrate lineages that all undertake powered flight, a ventral extension of the sternum, named the keel, has evolved independently, most strikingly in volant birds. In flightless birds, however, the sternal keel is absent, and the sternum is flattened. We review studies in a variety of species that have analysed adaptations in sterna morphology that are related to the animal’s mode of locomotion on land, in the sky and in water.
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Rufa, Magdalena, Adrian Ursulescu, Petra Baumann, and Manel Ferrer. "A Bicentric, International, Retrospective Study to Assess Steelex Sternum Set for Sternal Closure in Cardiac Surgery – STERCCAS a Cohort Study." Journal of Surgery 12, no. 2 (April 17, 2024): 37–44. http://dx.doi.org/10.11648/j.js.20241202.14.
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Sternal fixation with steel wires or cerclages, is the gold standard for closing a midline sternotomy, the standard incision in cardiac surgery. Rare wound complications can occur following a sternotomy wire closure. The objective of this study is to establish that the clinical efficacy of the Steelex Sternum Set is equivalent to the results documented in existing literature. The cohorts of the previously conducted OPTICABG and PREMIVALVE studies served as a foundation for the design of this retrospective, bicentric, international, single-arm study. The purpose of the study was to evaluate the clinical performance of the Steelex Sternum Set for sternal closure after coronary artery bypass grafting or cardiac valve replacement/reconstruction surgery. The primary endpoint was the incidence of a composite consisting of sternum instability, sternum dehiscence, superficial and deep sternal wound infection up to six months after surgery. A quantitative summary of the available clinical literature has been conducted for comparison purposes. There were 229 patients in total (89 PREMIVALVE and 140 OPTICABG). The combined rate of surgical site infection and sternal dehiscence/instability was 3.49%, compared to 1.5 - 20% described in the literature. Severe complications such as mortality, stroke, myocardial infarction, and mediastinitis occurred in about 0.8 - 2% of cases. The Steelex Sternum Set is a safe and appropriate method for sternal closure in a diverse patient population undergoing cardiac valve replacement and/or reconstruction, as well as coronary artery bypass graft surgery, in routine clinical settings.
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Rizvi, Shaheen Sajid Abbas, and Sharadkumar Pralhad Sawant. "Morphometric assessment of sternal foramina and sternal variations." Indian Journal of Clinical Anatomy and Physiology 11, no. 1 (May 15, 2024): 42–49. http://dx.doi.org/10.18231/j.ijcap.2024.008.
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The sternum is a crucial component of the thoracic cage. Its articulations and divisions play an important role in providing structural support to the thoracic cage and facilitating movements. The body of the sternum originates from four mesenchymal bars known as sternebrae, Incomplete fusion of the sternebrae or failure of fusion can lead to the development of a sternal foramen. The clinical significance of a sternal foramen lies in the potential risks associated with medical procedures such as acupuncture or sternal puncture for bone marrow biopsy. A study was conducted on 100 sterna at K. J. Somaiya Medical College to find out the presence of sternal foramen, to study their site, size and shape and to discuss its clinical Implications. 20% of the specimens were found to possess a sternal foramen. The vertical to transverse diameter of these foramina were in the range of 4.4 – 6.9mm. Most of the foramen were found to be at the level of 3 and 4 costal notches followed by Xiphoid process. The study also observed the variations in the shape of the manubrium and the body of the sternum and the variations of the Xiphoid process. Failure to recognize the presence of sternal foramina can pose serious risks during medical procedures, potentially leading to damage to the pericardium and heart. Therefore, it is essential for healthcare practitioners to be aware of these variations and consider obtaining X-ray or CT scans to assess sternum morphology before performing invasive procedures. The study emphasizes the importance of comprehensive anatomical knowledge and careful clinical assessment when dealing with the sternum and underscores the need for precautionary measures to prevent complications associated with sternal foramina.
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Charyshkin, A. L., and A. A. Guryanov. "First results of using a bidirectional U-shaped sternal suture in patients who have suffered a deep sternal infection." Grekov's Bulletin of Surgery 180, no. 4 (June 27, 2021): 51–56. http://dx.doi.org/10.24884/0042-4625-2021-180-4-51-56.
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Introduction. Sternomediastinitis in patients undergoing open heart operation remains a formidable complication. Treatment of a sternal infection is a complex and multi-component process. Closing of the sternal wound is one of the decisive steps in the treatment of sternomediastinitis. This is due to the fact that an insufficiently static state of the sternum in itself leads to a relapse of purulent-septic complications. At the same time, we have to work with non-native bone that has undergone inflammatory and destructive changes and multiple mechanical damage.The objective of the study was to evaluate the results of using the developed bidirectional U-shaped sternal suture for reosteosynthesis of the sternum in patients after postoperative mediastinitis.Methods and materials. The results of treatment of 16 patients with deep sternal infection in the early postoperative period were analyzed. All patients were divided into two groups according to the type of used sternal sutures. The first group consisted of 8 patients in whom a developed bidirectional U-shaped sternal suture was used for sternum reosteosynthesis. In the second group, in 8 patients, the sternal cusps were brought together using classic sternal figure-of-8 suture. A two-stage tactics of treatment was used both in the first and in the second groups of patients. Surgical debridement of the wound with removal of the primary sternal sutures was performed in the first stage. Subsequently, vacuum-assisted therapy was carried out using antiseptics. The second stage was the closure of the sternal wound after cleaning and decontamination of the wound.Results. Signs of sternal suture failure were not observed in the first group. Three patients underwent repeated plasty of the sternum due to the incompetence of the sternal sutures in the second group. One patient had relapse of wound infection.Conclusion. The developed bi-directional U-shaped sternal suture in patients after postoperative sternomediastinitis provides the prevention of inconsistency of sternum.
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Al Ebrahim, Khalid. "Reinforced Sternal Closure: The Bilateral Straight Longitudinal Wire Technique." Asian Cardiovascular and Thoracic Annals 11, no. 1 (March 2003): 90–91. http://dx.doi.org/10.1177/021849230301100126.
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Sternal dehiscence and mediastinitis are among the most severe complications of median sternotomy. A simplified technique of reinforced closure is described. A straight wire is inserted longitudinally on each side of the sternum, placed within the transverse wires when the latter are approximated. Using this technique in 112 patients with a precarious sternum, no cases of sternal dehiscence or mediastinitis have been seen.
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Karki, Raj Kumar, Pankaj Kumar Singh, Subindra Karki, and Dhiraj Kumar Shah. "Sex- related morphometric difference in sternal index and dimensions amongst Nepalese adults." Journal of Gandaki Medical College-Nepal 13, no. 2 (December 25, 2020): 104–10. http://dx.doi.org/10.3126/jgmcn.v13i2.30729.
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Introduction: The comprehensive goal in forensic anthropology is the identification of skeletal remains for which researchers are constantly working to produce methods that are as accurate as possible. Because of distinct sexual dimorphism, bones of the pelvis and skull are preferred; however, when these bones are unavailable other bones like sternum have to be used as it holds a great deal of sexual dimorphism.
Objective: To evaluate sexual dimorphism in the metric parameters of the sternum through MDCT images amongst Nepalese adults.
Materials and Methods: Sternal dimensions of 105 study participants (62 male and 43 female) were measured using Computed Tomography (CT) images from Radiology Department of Dhulikhel Hospital. An independent t test was performed to assess the strength of association between different variables and genders. Differences were considered significant at P < 0.05. ROC curve analysis was done to determine the discriminating power of variables for sex determination.
Result: The different measurements of sternal lengths were significantly greater in male than females(p<0.001) except Sternal Index which was found to be higher in female (p<0.001). Despite this difference in mean, most of the sterna were in overlapping zone. The limiting point of 126 was determined for total sternum which could correctly classify majority of sternum. Using ROC curve the mesosternum and total sternum were found to be most accurate (>95%) in sex determination. Hyrtl’s law could classify 91.9% of the male and Ashley’s rule of 136 could 97.67% of the female.
Conclusion: Hence this study made an effort in sexing the sternum in Nepalese population amongst which mesosternal length and total sterna length were found to be best estimators of sex whereas manubrium length and sternal index were not found to be satisfactory.
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Skryabin, Evgeny G., Sergey V. Naumov, Pavel B. Zotov, and Mikhail A. Akselrov. "Sternal fractures in children." Pediatric Traumatology, Orthopaedics and Reconstructive Surgery 9, no. 3 (October 4, 2021): 317–25. http://dx.doi.org/10.17816/ptors64202.
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BACKGROUND: Sternal fractures are a rare nosological form of injuries in children. The injuries of the sternum often are accompanied by fractures of the long bones of the skeleton or thoracic vertebrae. Isolated fractures of the sternum in children are rarely diagnosed. The medical information on pediatric sternum injuries is limited by a small number of scientific publications.
AIM: Our aim is to study the peculiarities of traumagenesis, clinic, diagnostics, treatment of sternal fractures in children.
MATERIALS AND METHODS: Clinical material for the served as experience in providing traumatology assistance to 8 children who received sternal fractures. The average age of the injured children was 11.5 years. 87.5% of the victims were boys. In all patients, sternal fractures had been diagnosed along with other damage to the musculoskeletal system. During the survey, traditional diagnostic methods for emergency traumatology were used.
RESULTS: The leading mechanism of injury, i.e., falling from a height of 2 meters and more were found in 62.5% of victims. In all clinical observations, fractures were localized at the level of the body of the sternum. All the children, besides sternal fractures, had uncomplicated fractures of the vertebral bodies. A total of 30 bodies of the vertebrae were compressed. Most often (in 16.75% of cases), the ThV vertebra was compressed. The reliable symptoms of sternal fractures in patients were difficult and painful breathing, local swelling of soft tissues, soreness of the sternum during palpation, and amplification of the pain in the fracture area during pressure applied on half of the chest. Compliance with the strict bed mode on the roller-reclinator under the area of the compreated vertebrae and the exclusion of the axial load on the spine was a favorable fact sufficient and led to pain disappearance in 37 days. In all cases, the sternum fractures did not require any surgery. Fractures of the bodies of the vertebrae in 7 children were also treated conservatively. The Corsets Orlett was used for immobilization, ensuring a reliable degree of fixation. The average hospital stay amounted to 16. The duration of the hospital stay was influenced by the accompanying bone-articular damage to the skeleton. The evaluation of the long-term results was performed in 4 children. The results were interpreted as good.
CONCLUSIONS: When applying for emergency traumatology assistance to children with chest injury and spine, it is necessary to purposefully explore the state of the sternum.
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Janilionis, Ričardas, Pierre-Emmanuel Falcoz, Vytautas Jovaišas, Žymantas Jagelavičius, and Ramūnas Valančius. "Sternal pseudoarthrosis after resternotomy treated with the Strasbourg Thoracic Osteosyntheses System: a case report." Acta medica Lituanica 20, no. 3 (November 6, 2013): 129–34. http://dx.doi.org/10.6001/actamedica.v20i3.2728.
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Sternal dehiscence is a serious complication after general thoracic and cardiac surgery. Sternal resuturing, performed by simple rewiring or technical modification of rewiring, can fail overall when the bone quality is poor or the sternum is completely destroyed. A number of different sternal closure systems, consisting of plates, screws, clips and titanium bars, have been recently intoduced to treat the complicated sternal dehiscence. We describe the use of the Strasbourg Thoracic Osteosyntheses System (STRATOS) to treat complicated sternal dehiscence causing chest and back pain, sternum and chest instability, which was applied for the first time in Lithuania.
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Carsote, Mara, Dana Terzea, Florina Vasilescu, Anca-Pati Cucu, Adrian Ciuche, and Claudiu Nistor. "Sternum Metastases: From Case-Identifying Strategy to Multidisciplinary Management." Diagnostics 13, no. 16 (August 17, 2023): 2698. http://dx.doi.org/10.3390/diagnostics13162698.
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We aimed to overview the most recent data on sternal metastases from a multidisciplinary approach (diagnosis strategies, outcome, and histological reports). This narrative review based on a PubMed search (between January 2020 and 22 July 2023) using key words such as “sternal”, “manubrium”, and “metastasis” within the title and/or abstract only included original papers that specifically addressed secondary sternal spreading of cancer in adults, for a total of 48 original articles (14 studies and 34 single case reports). A prior unpublished case in point is also introduced (percutaneous incisional biopsy was used to address a 10 cm sternal tumour upon first admission on an apparently healthy male). The studies (n = 14) may be classified into one of three groups: studies addressing the incidence of bone metastases (including sternum) amid different primary cancers, such as prostate cancer (N = 122 with bone metastases, 83% of them with chest wall metastases), head and neck cancers (N = 3620, 0.8% with bone metastases, and 10.34% of this subgroup with sternum involvement); and glioblastoma (N = 92 with bone metastases, 37% of them with non-vertebral metastases, including the sternum); assessment cohorts, including breast cancer (N = 410; accuracy and sensitivity of PET/CT vs. bone scintigraphy is superior with concern to sternum spreading) and bone metastases of unknown origin (N = 83, including a subgroup with sternum metastases; some features of PET/CT help the differentiation with multiple myeloma); and cohorts with various therapeutic approaches, such as palliative arterial embolization (N = 10), thymic neuroendocrine neoplasia (1/5 detected with sternum metastases), survival rates for sternum metastases vs. non-sternum chest wall involvement (N = 87), oligo-metastatic (sternal) breast cancer (3 studies, N = 16 for all of them), oligo-metastatic head and neck cancer (N = 81), conformal radiotherapy (N = 24,215, including an analysis on sternum spreading), and EBRT followed by MR-HIFU (N = 6). Core data coming from the isolated case reports (N = 34) showed a female to male ratio of 1.6; the females’ ages were between 34 and 80 (mean of 57.28) and the males’ ages varied between 33 and 79 (average of 58.78) years. The originating tumour profile revealed that the most frequent types were mammary (N = 8, all females) and thyroid (N = 9, both women and men), followed by bladder (N = 3), lung (N = 2), and kidney (N = 2). There was also one case for each of the following: adenoid cystic carcinoma of the jaw, malignant melanoma, caecum MiNEN, a brain and an extracranial meningioma, tongue carcinoma, cholangiocarcinoma, osteosarcoma, and hepatocellular carcinoma. To our knowledge, this is the most complex and the largest analysis of prior published data within the time frame of our methods. These data open up new perspectives of this intricate, dynamic, and challenging domain of sternum metastases. Awareness is a mandatory factor since the patients may have a complex multidisciplinary medical and/or surgical background or they are admitted for the first time with this condition; thus, the convolute puzzle will start from this newly detected sternal lump. Abbreviations: N = number of patients; n = number of studies; PET/CT = positron emission tomography/computed tomography; EVRT = external beam radiotherapy; MR-HIFU = magnetic resonance-guided high-intensity focused ultrasound; MiNEN = mixed neuroendocrine-non-neuroendocrine tumour.
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Ma, Qin-Yun, Yong-Jun Zhu, Lie-Wen Pang, Gang Chen, Ji Chen, and Zhi-Ming Chen. "Application of the Titanium Plate Fixation System in Sternum Transverse Incisions." American Surgeon 77, no. 11 (November 2011): 1477–82. http://dx.doi.org/10.1177/000313481107701137.
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The purpose of this study was to review the application of the titanium plate fixation system in sternum transverse incisions and assess its advantages over the conventional methods of steel wire fixation. Sternal healing of 249 patients who underwent a thymectomy and/or excision of the thymoma with a transverse sternal incision was compared between patients who underwent titanium plate fixation or steel wire fixation. Short-term results: The stability of the sternum was significantly superior in the titanium plate group compared with the steel wire group ( P < 0.01). Out-of-bed activities started earlier for patients in the titanium plate group compared with the steel wire group ( P < 0.01). Long-term results: The sternal healing rate in the titanium plate group was significantly higher than the steel wire group ( P < 0.05). Titanium plate fixation improves the postoperative sternal stability in patients with transverse sternal incisions for thymectomy and/or excision of a thymoma. Titanium plate fixation also reduces postoperative pain, enhances the patient's physical activity, and decreases the long-term nonunion rate of the sternum.
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Duchania, Sunil Kumar. "Correlation between Estimated and Actual Age of Fusion of Mesosternum with Manubrium Sterni and Xiphisternum." International Journal of Forensic Sciences 7, no. 3 (2022): 1–6. http://dx.doi.org/10.23880/ijfsc-16000271.
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Objectives: This article documents the correlation between age of estimated and observed age of fusion of sternum bone, particularly when evaluating skeletonized human remains. Methods: Soft tissues removed from the macerated sterna by blunt dissection and the fusion of body of sternum with manubrium sterni and xiphisternum are recorded. Results: On statistical analysis for correlation between actual and estimated age correlation coefficient is 0.908 and p-value is 0.0001 that is statistically significant. Conclusion: The correlation results indicate that there is statistically insignificant difference between the actual age of the subject and estimated age from fusion of sternal joints. None of studies assesses on determination of age from sternum has compared actual age of the individuals with estimated age devised from Sternal samples.
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Alif Arfiansyah Kartono, Gama Satria, and Erial Bahar. "Comparison of Sternum Approximation Stability Using Stainless Steel Wire with Polydioxanone (PDS)." Sriwijaya Journal of Surgery 5, no. 2 (December 1, 2022): 515–20. http://dx.doi.org/10.37275/sjs.v5i2.79.
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Background: The median sternal incision is an incision that is commonly done in heart surgery and vascular surgery. The existing techniques need elaboration and innovation to produce a method with an optimal level of healing effectiveness accompanied by a minimal risk of side effects. This study aims to determine the difference between sternal approximation using stainless steel wire compared to polydioxanone (PDS) based on biomechanical analysis.
Methods: This was an in vitro experimental study using the sternum of a goat. A total of 24 sternums were divided into 6 treatment groups. Data analysis was performed with SPSS version 20. Univariate and bivariate analyzes were performed to compare the sternal approximation between stainless steel wire and PDS.
Results: The use of PDS showed a higher average increase in transverse and longitudinal approximations compared to the use of stainless steel wire and was statistically different, p<0.05. PDS does not differ from stainless steel wire in lateral approximation.
Conclusion: Stainless steel wire is more optimal in maintaining sternal stability than PDS based on biomechanical tests.
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Kuznetsov, D. V., A. A. Gevorgyan, V. V. Novokshenov, K. M. Mikhailov, A. V. Kryukov, and S. M. Khokhlunov. "Longitudinal-cross-linking method of the sternum osteosynthesis – an additional way for the prophylaxis of deep sternal infection in cardiac surgery patients." Grekov's Bulletin of Surgery 179, no. 3 (August 3, 2020): 25–32. http://dx.doi.org/10.24884/0042-4625-2020-179-3-25-32.
Full textAbstract:
The OBJECTIVE of the study was to compare the results of using the longitudinal – cross-linking method of sternum osteosynthesis with other methods (single wire stitches, 8-shaped wire stitches) for cardiosurgery patients.METHODS AND MATERIALS. The study included 3,150 patients, which were operated on in Samara cardiology dispensary named after V. P. Poliakov from 2012 to 2018. Patients were divided into 2 groups. Group 1 (1397 patients, operated on from 2012 to 2014) used single wire stitches or 8-shaped wire stitches for sternum osteosynthesis. Group 2 (1753 patients, operated from 2015 to 2018) used the longitudinal -cross-linking method of sternum osteosynthesis. The incidence of instability of the sternum without infection, superficial postoperative wound infection, deep sternal infection and hospital mortality were evaluated.RESULTS. Groups (1–68 % of men, average age (59.4±9,9) years; 2–68 % of men, average age 62.3±8.5) were significantly different in obesity patients (25.6 & 29.3 %, p=0.02), amount of smokers (50.5 & 64.2 %, p<0.001) and amount of urgent cases (3 & 10 %, p<0.001). The incidence of sternal instability without infection was less in group 2 (0.64 & 0.29 %; OR, 2.29; 95 % CI, 0.76 to 6.8; p=0.1). The amount of deep sternal infection was significant less in group 2 (1.6 & 0.6 %; OR, 2.53; 95 % CI, 1.2 to 5.2; p=0.009). The hospital mortality was 3.9 % in group 1 and 2.96 % in group 2 (OR, 1.34; 95 % CI, 0.9 to 1.9; p=0.1).CONCLUSION. The longitudinal-cross-linking method of sternum osteosynthesis is the available method that can significantly reduce the incidence of deep sternal infection in cardiosurgery.
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Sheikhy, Kambiz, Azizollah Abbasi Dezfouli, and Farahnaz Sadegh Beigee. "Reconstruction of Chest Wall by Cryopreserved Sternal Allograft after Resection of Aneurysmal Bone Cyst of Sternum." Case Reports in Surgery 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/9135657.
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A 20-year-old female was referred to our hospital due to deformity and bulging in anterior aspect of chest wall in sternal area. Chest X-ray and CT scan confirmed a large mass with destruction of sternum. Pathologic diagnosis after incisional biopsy was compatible with aneurysmal bone cyst. We resected sternum completely and reconstructed large anterior defect by a cryopreserved sternal allograft. In follow-up of patient there was no unstability of chest wall with good cosmetic result.
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Janilionis, Ričardas, Pierre-Emmanuel Falcoz, Vytautas Jovaišas, Žymantas Jagelavičius, and Ramūnas Valančius. "Krūtinkaulio pseudoartrozės po resternotomijos gydymas Strasbūro krūtinės osteosintezės sistema: klinikinis atvejis." Lietuvos chirurgija 11, no. 3-4 (January 1, 2012): 112–15. http://dx.doi.org/10.15388/lietchirur.2012.3.2860.
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Sternal pseudoarthrosis after resternotomy treated with the Strasbourg Thoracic Osteosyntheses System: a case report Sternal dehiscence is a serious complication after general thoracic and cardiac surgery. Sternal resuturing, performed by simple rewiring or technical modification of rewiring, can fail overall when the bone quality is poor or the sternum is completely destroyed. A number of different sternal closure systems consisting of plates, screws, clips, and titanium bars have been recently introduced to treat the complicated sternal dehiscence. We describe the use of the Strasbourg Thoracic Osteosyntheses System (STRATOS) to treat complicated sternal dehiscence causing chest and back pain, sternum and chest instability, which was applied for the first time in Lithuania.Key words: sternotomy, sternal pseudoarthrosis, sternal osteosynthesis, chest instability, STRATOS.
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Janilionis, Ričardas, Pierre-Emmanuel Falcoz, Vytautas Jovaišas, Žymantas Jagelavičius, and Ramūnas Valančius. "Krūtinkaulio pseudoartrozės po resternotomijos gydymas Strasbūro krūtinės osteosintezės sistema: klinikinis atvejis." Lietuvos chirurgija 11, no. 3-4 (January 1, 2012): 112–15. http://dx.doi.org/10.15388/10.15388/lietchirur.2012.3.2860.
Full textAbstract:
Sternal pseudoarthrosis after resternotomy treated with the Strasbourg Thoracic Osteosyntheses System: a case report Sternal dehiscence is a serious complication after general thoracic and cardiac surgery. Sternal resuturing, performed by simple rewiring or technical modification of rewiring, can fail overall when the bone quality is poor or the sternum is completely destroyed. A number of different sternal closure systems consisting of plates, screws, clips, and titanium bars have been recently introduced to treat the complicated sternal dehiscence. We describe the use of the Strasbourg Thoracic Osteosyntheses System (STRATOS) to treat complicated sternal dehiscence causing chest and back pain, sternum and chest instability, which was applied for the first time in Lithuania.Key words: sternotomy, sternal pseudoarthrosis, sternal osteosynthesis, chest instability, STRATOS.
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Jutley, Rajwinder S., Duncan E. T. Shepherd, David W. L. Hukins, and Robert R. Jeffrey. "Preliminary Evaluation of the Sternum Screw: A Novel Method for Improved Sternal Closure to Prevent Dehiscence." Cardiovascular Surgery 11, no. 1 (February 2003): 85–89. http://dx.doi.org/10.1177/096721090301100116.
Full textAbstract:
Sternal dehiscence is a relatively rare but serious complication of sternal closure with an unacceptable mortality and morbidity rate. The 6 mm cannulated Sternum Screws are a novel approach that aims to prevent dehiscence. The screws are placed on either side of the sternotomy and wire threaded through the cannula and closed customarily. The Sternum Screws make the bone non-penetrable at the same time retaining the familiarity of conventional stainless steel wire. This novel technique was tested in sheep sterna to compare its efficacy to conventional wire closure. Using tensile testing in a testing machine, randomised controlled closures of the Sternum Screws and No. 5 stainless steel wires were evaluated until system failure. Seventeen matched pairs were tested. The Sternum Screw closure was on average 36% stronger, 284±43 N (mean±SD) compared to conventional wire closure alone. 215±38 N (mean±SD) [ p<0.0001 by t-test]. System failure in 82% of Sternum Screw closures, however, was due to wire breakage or untwisting rather than the screw itself. In all these cases the screw remained intact in bone. 71% of conventional wire closures failed by dehiscing through the sterna. The mean forces required for wire dehiscence and wire failure in the Sternum Screws may be achieved in vivo during large coughs. The study shows there is merit in further evaluating the approach as a method-of preventing dehiscence. It also highlights the use of alternative wiring techniques increase the tensile strength of the closure yet retain the familiarity and versatility of conventional wire.
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Stacy, Gregory S., Osmanuddin Ahmed, Arlene Richardson, Brian M. Hatcher, Heber MacMahon, and Jaishankar Raman. "Evaluation of Sternal Bone Healing with Computed Tomography and a Quantitative Scoring Algorithm." Open Medical Imaging Journal 8, no. 1 (November 26, 2014): 29–35. http://dx.doi.org/10.2174/1874347101408010029.
Full textAbstract:
Objective: The exquisite bone detail offered by computed tomography makes it the ideal modality for evaluation of bone healing. However, few studies have investigated the normal computed tomographic appearance of the sternum after median sternotomy and, to the best of our knowledge, no computed tomographic classification of sternal healing has been proposed. Given the potential benefit of objective criteria, we propose a validated scoring classification of sternal healing using computed tomography for both clinical and investigational purposes. Methods: Computed tomography scans from 20 patients who underwent a median sternotomy were evaluated for sternal healing at either 3 or 6 months postoperatively. Five anatomic locations along the sternum were selected using defined criteria, and a 6-point quantitative scale was developed to evaluate sternal healing. Independent radiologists read and scored each of the 5 locations on the sternum. Inter- and intra-observer variability was assessed by calculating the kappa statistics to measure the reliability of the scoring algorithm. Results: Calculation of the kappa statistics indicated substantial agreement for intra-observer variability and substantial to almost perfect agreement for inter-observer variability. For intra-observer variability, the kappa statistics ranged from 0.591 to 0.802, and for inter-observer variability, the kappa statistics ranged from 0.590 to 0.969. When the two radiologists differed, the magnitude of the difference was no more than 1 or 2 points. Conclusion: This simple system of evaluating sternal healing had high inter- and intra-observer reliability. Therefore, it may be considered a valid method for assessing sternal osteosynthesis for both clinical and investigative purposes. Ultramini abstract: (49 words): Few studies have investigated the normal computed tomography appearance of the sternum after median sternotomy, and we knew of no computed tomography-based classification of sternal healing. Given the potential benefit of objective criteria, we designed and validated a scoring classification of sternal osteosynthesis for both clinical and investigational purposes.
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Gokce, Anil, Seyhan Babaroglu, Hasan Murat Ergani, and Yucel Akkas. "Multidisciplinary Surgery in Thoracic Wall Reconstruction for Sternal Osteomyelitis." Clinics in Surgery 6, no. 1 (May 1, 2016): 1–3. http://dx.doi.org/10.25107/cis-v6-id3075.
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Abstract Sternal osteomyelitis and dehiscence are a common problem with an incidence rate of 0.5% to 5.0% after major cardiac surgery. However, the management of separation of the sternum in the patient's thorax remains a challenge for cardiac surgeons and thoracic surgeons using the incision. After cardiac surgery, post-op sternal dehiscence and osteomyelitis was developed in the patient. The old steel wires were removed and the sternum was resected due to long-term infection and extensive deformation of the sternum. Pectoralis muscle flaps were partially mobilized and adducted. The large defect was closed using a large prolene patch. Proper sized transversal titanium plates were selected. Due to the sternum bone was severely destroyed by infection, longer transversal titanium plates were chosen to achieve thoracic stability. Healthy tissues were detected on the ribs. A total of 4 titanium plates were placed intermittently. The plates were fixed to the ribs with titanium locking screws. The pectoral muscle flaps adducted to the plates by the plastic surgery team. A total of 3 drains were placed, one in the mediastinum and two between the thoracic wall and muscle structures.
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Hamon, Martin, Philippe Haudiquet, and Aurelie Bruwier. "Sternal Dislocation and Associated Lung Lobe Hernia in a Cat." Case Reports in Veterinary Medicine 2024 (May 14, 2024): 1–4. http://dx.doi.org/10.1155/2024/3719641.
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Sternal luxation/dislocation is a rare condition and is most often the result of trauma. Medical and surgical management have been described, with scarce information regarding the best treatment option for these cases. A 1-year-old domestic shorthair cat was presented for severe sternal dislocation and a left humeral fracture. Given the displacement observed at the level of the sternum and pain associated, surgical stabilization was elected. A partial lung lobe hernia was identified during the open stabilization of the sternum. Management of the hernia and sternal luxation stabilization were performed with the aid of video-assisted thoracoscopy. The cat recovered uneventfully, and no postoperative complications were reported.
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Kaneps, Andris J., Michael J. Huber, and Stanley P. Snyder. "Comparison of autogenous cancellous bone grafts obtained from the sternum and proximal portion of the tibia of llamas." Journal of the American Veterinary Medical Association 215, no. 3 (August 1, 1999): 362–65. http://dx.doi.org/10.2460/javma.1999.215.03.362.
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Objective To describe the anatomy of the sternum in llamas, define the surgical approach to the sternum for collection of cancellous bone graft tissue, and compare the histologic appearance of graft tissue obtained from the sternum with that obtained from the proximal portion of the tibia. Design Prospective study. Animals 12 llamas, 3 to 19 years old, that had been submitted for necropsy. Procedure Radiographs were taken of the sternum and left tibia of the llamas. Measurements of the sternum were determined from the radiographs and adjusted for magnification. Sternebrae volumes were estimated from these measurements. Anatomic dissections to the center of the fourth sternebra and the proximal portion of the tibia were made, and a surgical approach to the sternum was developed. Cancellous graft tissue was obtained from each site and submitted for histologic evaluation. Results Sternebrae 3, 4, and 5 were significantly larger in volume than the other sternebrae. The ventral aspect of the fourth sternebra was readily accessed for removal of graft tissue by making a 6-cm-long ventral midline incision centered 17 cm craniad to the xiphoid. Mean soft tissue thickness overlying the ventral aspect of the fourth sternebra was 3.1 cm. More tissue was obtained from the sternal (mean, 9.11 g) than from the tibial (mean, 5.16 g) sites. Sternal graft tissue consisted of trabecular bone spicules with predominantly hematopoietic marrow, whereas tibial tissue consisted of trabecular bone spicules with only fatty marrow. Conclusions and Clinical Relevance The fourth sternebra in llamas is readily accessible for obtaining autogenous cancellous bone graft tissue that consists of predominantly hematopoietic marrow. (J Am Vet Med Assoc 1999;215:362–365)
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Duzgun, Ali Cemal, Ekin Ilkeli, and Fehmi Katircioglu. "Comparison of Two Sternal Closure Techniques Based on Risk Factors: A Prospective, Observational Study." Applied Bionics and Biomechanics 2021 (October 8, 2021): 1–6. http://dx.doi.org/10.1155/2021/2169431.
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Background. Stainless steel wires are still commonly used as a sternum closure technique. However, it can cause fatal complications due to rupture and dehiscence. It was anticipated that the sternal Cable System (Pioneer Surgical Technology Inc., Marquette, MI, USA) could provide a better sternal fixation and reduce the possible complications. Materials and Method. A total of 100 patients (57 male, 43 female) at high risk of dehiscence were included in this prospective observational study. Among those with EuroSCORE value of 4 and above, patients with chronic lung disease, chronic kidney disease, diabetes mellitus, obesity, smoking, body mass index, advanced age, and resurgery were operated in two separate centers. Standard steel wires ( n : 51) used for sternotomy were compared with the sternal cable ( n : 49). Early and late sternal dehiscence rates were compared in the study. The relationship between risk factors causing dehiscence and both methods was assessed statistically. Results. Early dehiscence rates were 6.4% in those closed with a sternal cable ( n : 3) and 11.8% in those closed with a sternal wire ( n : 6) ( p < 0.05 )). In risky patients, body mass index was the most determining parameter in terms of sternum dehiscence risk. Conclusion. In risky patients, we recommend the sternal cable system as a good and reliable closure technique to achieve a more stable and compact sternum.
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Jones, Denise F., Abigail R. McRea, James D. Knowles, Feng-Chang Lin, Erin Burnette, Lara A. Reller, and Jacob A. Lohr. "A Prospective Comparison of Transcutaneous and Serum Bilirubin Within Brief Time Intervals." Clinical Pediatrics 56, no. 11 (April 3, 2017): 1013–17. http://dx.doi.org/10.1177/0009922817701170.
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The American Academy of Pediatrics recommends screening newborns ≥35 weeks’ gestation with total serum bilirubin (TSB) or transcutaneous bilirubin (TcB) to detect hyperbilirubinemia. Retrospective studies show TcB measurements strongly correlate with TSB; however, few prospective trials document this relationship. Furthermore, Dräger’s newest TcB instrument, JM-105, remains unstudied in the United States. We measure TcB on foreheads and sternums of newborns using JM-105 and Bilichek devices within 30 minutes of TSB measurement. We find best overall TcB/TSB correlation with JM-105 on the sternum (mean TcB-TSB difference: −0.21 ± 1.15 mg/dL). Correlations between paired measurements for TcB on the sternum using JM-105 were 0.93 for all TSB levels (n = 178), 0.82 for TSB > 10 (n = 19), 0.69 for TSB > 12 (n = 11), and 0.52 for TSB > 15 (n = 6). TcB accuracy via JM-105 on the sternum significantly differed among races ( P < .001). For 5% of paired measurements, TcB with JM-105 on the sternum underestimated TSB by ≥2 mg/dL, and for <1% by ≥3 mg/dL.
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Li, Yanying, Hehe Liu, Lei Wang, Yang Xi, Jiwen Wang, Rongping Zhang, Liang Li, Lili Bai, and Ahsan Mustafa. "Evidence Supporting the Regulatory Relationships through a Paracrine Pathway between the Sternum and Pectoral Muscles in Ducks." Genes 12, no. 4 (March 24, 2021): 463. http://dx.doi.org/10.3390/genes12040463.
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Muscles and bones are anatomically closely linked, and they can conduct communication by mechanical and chemical signals. However, the specific regulatory mechanism between the pectoral muscle and sternum in birds was largely unknown. The present study explored the potential relationship between them in ducks. The result of the sections showed that more nuclei in proliferate states were observed in the pectoral muscle fibers attached to the calcified sternum, than those attached to the un-calcified sternum. The RNA-seq identified 328 differentially expressed genes (DEGs) in the sternum between the calcified and un-calcified groups. Gene ontology (GO) showed that the DEGs were mainly enriched in pathways associated with calcification. In addition, DEGs in the muscles between the calcified and un-calcified sternum groups were mainly annotated to signal transduction receptor pathways. The expression patterns of genes encoding for secreted proteins, in bone (CXCL12, BMP7 and CTSK) and muscle (LGI1), were clustered with muscle development (MB) and bone calcification (KCNA1, OSTN, COL9A3, and DCN) related genes, respectively, indicating the regulatory relationships through a paracrine pathway existing between the sternum and pectoral muscles in ducks. Together, we demonstrated that the pectoral muscle development was affected by the sternal ossification states in ducks. The VEGFA, CXCL12, SPP1, NOG, and BMP7 were possibly the key genes to participate in the ossification of the duck sternum. We firstly listed evidence supporting the regulatory relationships through a paracrine pathway between the sternum and pectoral muscles in ducks, which provided scientific data for the study of the synergistic development of bone and skeletal muscle.
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Boiko, Valerii Volodymyrovych, Viktor Nikolaevich Lykhman, D. O. Myroshnychenko, Ya V. Shafer, Sergei Valerevich Tkach, Andrei Alekseevich Merkulov, Ye O. Bilodid, and O. V. Nedilko. "OSTEOMYELITIS OF STERNUM: DIAGNOSIS AND SURGICAL TREATMENT." International Medical Journal, no. 4(104) (December 24, 2020): 25–28. http://dx.doi.org/10.37436/2308-5274-2020-4-4.
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Postoperative sternomediastinal infections significantly affect morbidity and mortality, as well as the hospitalization duration and treatment cost for cardiac surgery patients. The use of median sternotomy has a number of complications, primarily infectious, which can occur with the formation of superficial or deep wound infection, diastase and fragmentation of the sternum, and sometimes with destabilization of the chest bony skeleton. The development of sternal osteomyelitis is associated with a significant reduction in long−term survival. The results of treatment for the patients with the sternum osteomyelitis after sternotomies, being at the State Institution "V. T. Zaitsev Institute of General and Emergency Surgery of the NAMS of Ukraine" in Kharkiv within the period of 2014−2020, have been analyzed. Diagnosis of patients with osteomyelitis of the sternum comprised fistulography, multispiral computed tomography, ultrasound. The material for the bacterial study was the discharges of a sternal wound. Antibiotic susceptibility of isolated bacterial cultures was studied by disco−diffusion and in agar. There were 32 strains of microorganisms, representatives of different taxa. S. aureus was dominant and accounted for 23.81 % of the total number of isolates of this genus. Among antibiotics, the most effective in vitro were lincomycin and especially carbapenems (imipenem). When treating the patients with sternal osteomyelitis, VAC therapy was used, as well as open wound management by dressings depending on the wound process stage. The results of the study suggest that multi−slice computed tomography should be preferred in the diagnosis of osteomyelitis of sternum, which allows the diagnosis verification in 98 % of cases, and the use of ultrasonography is important to monitor the clearance and healing of sternotomy wounds. The use of VAC therapy has helped to reduce the length of hospital stay of patients. Key words: sternum osteomyelitis, VAC therapy, multispiral computed tomography, bacterial culture.
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Désévaux, C., B. Martineau-Doizé, and S. Laverty. "Comparison of Histomorphometric Measurements of Equine Sternal Cancellous Bone with Bone from other Skeletal Sites." Veterinary and Comparative Orthopaedics and Traumatology 11, no. 03 (1998): 158–63. http://dx.doi.org/10.1055/s-0038-1632539.
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SummaryHistomorphometric analysis of bone biopsy specimens in humans is a reliable techniqu e which provides information on bone status and turnover. A techniqu e of sternal biopsy has been recently developed in “standin g horses” . The purpose of the present study was to demonstrate that the histomorphometric analysis of sternal cancellous bone was representative of other skeletal sites in horses.Post-mortem cancellous bone samples were obtained from the sternum, 12th rib, ilium, 1st lumbar vertebra and the tibia, of seven adult horses and embedded in methylmethacrylate. Sections, 7 μm thick, were cut and were stained with Goldner’s green trichrome. Histomorphometric parameters were measured by a semi-automated method. Sections from the sternum were qualitativel y similar to those from the rib, ilium and vertebra. Histomorphometric measurements were easily performed on the sternal, ilium, rib and vertebral sections. The tibial sections were not suitable for evaluation. The sternal histomorphometric parameters of bone formation and resorption were overall representative of those from other skeletal sites.The present study demonstrated that sternal cancellous bone is acceptable for bone histomorphometry in horses as it reflects overall skeletal osseous activity.This study compares qualitatively and quantitatively cancellous bone from the sternum, 12th rib, ilium, first lumbar vertebra and the tibia of seven adult horses. Sternal cancellous bone is acceptable for bone histomorphometry and reflects overall skeletal osseous activity.
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Narayanan, Santhosh, Divya Prakash, Gomathy Subramaniam, and Lakshminarayanan Mahadevan. "Anaplastic large cell lymphoma presenting as sternal swelling." International Journal of Advances in Medicine 5, no. 3 (May 22, 2018): 757. http://dx.doi.org/10.18203/2349-3933.ijam20182024.
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Lymphomas involving the sternum are very rare. We report a case of lymphoma presenting as lytic sternal lesion. A 14-year-old girl presented with history of painless swelling of central chest (sternum) of 3 months duration. Fine needle aspiration cytology from the site revealed anaplastic large cell lymphoma. It was confirmed by histopathology and immunohistochemistry. She underwent treatment with chemotherapy but succumbed to her illness after six months of treatment.
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Usawasuraiin, Pimpan, Borwon Wittayachamnankul, Boriboon Chenthanakij, Juntima Euathrongchit, Phichayut Phinyo, and Theerapon Tangsuwanaruk. "Optimal Landmark for Chest Compressions during Cardiopulmonary Resuscitation Derived from a Chest Computed Tomography in Arms-Down Position." Journal of Cardiovascular Development and Disease 9, no. 4 (March 27, 2022): 100. http://dx.doi.org/10.3390/jcdd9040100.
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Compressions at the left ventricle increase rate of return of spontaneous circulation. This study aimed to identify the landmark of the point of maximal left ventricular diameter on the sternum (LVmax) by using chest computed tomography (CCT) in the arms-down position, which was similar to an actual cardiac arrest patient. A retrospective study was conducted between September 2014 and November 2020. We included adult patients who underwent CCT in an arms-down position and measured the rescuer’s hand. We measured the distance from the sternal notch to LVmax (DLVmax), to the lower half of sternum (DLH), and to the point of maximal force of hand, which placed the lowest palmar margin of the rescuer’s reference hand at the xiphisternal junction. Thirty-nine patients were included. The LVmax was located below the lower half of the sternum; DLVmax and DLH were 12.6 and 10.0 cm, respectively (p < 0.001). Distance from the sternal notch to the point of maximal force of the left hand, with the ulnar border located at the xiphisternal junction, was close to DLVmax; 11.3 and 12.6 cm, respectively (p = 0.076). In conclusion, LVmax was located below the lower half of the sternum, which is recommended by current guidelines.
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ROTA, JADRANKA, and NIELS P. KRISTENSEN. "Note on taxonomic history, thoraco-abdominal articulation, and current placement of Millieriidae (Insecta: Lepidoptera)." Zootaxa 3032, no. 1 (September 19, 2011): 65. http://dx.doi.org/10.11646/zootaxa.3032.1.7.
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Ditrysia are the largest lepidopteran clade comprising about 99% of the order’s species richness (Kristensen & Skalski 1998). Currently, the group is classified into three superfamilies (Tineoidea, Gracillarioidea, and Yponomeutoidea) plus the large clade Apoditrysia (van Nieukerken et al. in press). A number of 20th century authors have studied morphological features of the second abdominal sternum (sternum II) in Ditrysia, particularly how the various sternal processes articulate with the metathorax (e.g., Börner 1939; Brock 1968, 1971; Kyrki 1983; Minet 1983, 1991). In the clade Apoditrysia, sternum II is highly modified, and this structure is considered the principal morphological synapomorphy supporting the monophyly of the clade (review: Kristensen 2003; see below for details).
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López de Victoria, Orlando, José Lev Álvarez Gómez, and Jaime Chévere Rivera. "Pitfalls of Robicsek 's Procedure: Safest Avant -Garde Alternatives to Reduce Sternum Surgical Complications." Revista Argentina de Cirugía Cardiovascular 21, no. 2 (December 21, 2023): 90–92. http://dx.doi.org/10.55200/raccv.v21.n3.0049.
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Robicsek's technique is a surgical methodology mainly used for sternal dehiscence, stabilization of the chest wall, and maintaining respiratory dynamics. Returning to an infected and anatomically altered scenario after cardiac surgery fosters a high risk of rupture, tears of previous repairs, and vascular bypasses. Classically, the dense adhesion of the left internal mammary artery to the posterior plate of the sternum makes the dissection of half of the fractured and dehisced sternum a prone situation for transection avulsion of the artery conduit, requiring ligating the most critical bypass to the heart. Our proposal brings a solid and safe surgical alternative to avoid dealing with the dangerous situation of dissecting the posterior sternum to perform Robicsek's procedure.
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Korbmacher, B., and S. Rammos. "Two-Stage Sternal Closure after Repair of Congenital Heart Disease in Neonates." Cardiovascular Surgery 1, no. 6 (December 1993): 660–63. http://dx.doi.org/10.1177/096721099300100610.
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Closure of the longitudinal sternal incision can lead to unacceptable impairment of the haemodynamic state after prolonged operation for complex congenital heart disease associated with decreased cardiac function which is caused by cardiac dilatation. Between 1981 and 1991, a two-stage sternal closure was used in 21 neonates with dilatation of the heart and low cardiac output after correction of congenital heart disease. The mean age at operation was 14 (range 4–30) days. In 15 patients (group 1), primary closure of the sternum was considered impossible in the operating room; in the remaining six (group 2). the sternum was reopened on the day of operation or on the first or second day after repair. Three of these newborn infants had a total anomalous pulmonary venous connection and 18 a simple transposition of the great arteries. In all patients, temporary closure of the thorax with a dura mater patch was performed. The patch was usually removed on day 4 after operation in the intensive care unit and followed by uncomplicated routine chest closure. There were no problems with mediastinitis, wound infection, osteomyelitis or instability of the sternum. Subsequent deformity of the thorax was not observed. Some 11 of 15 children (73%) of group 1 and four of six (66%) of group 2 survived. Leaving the sternum open resulted In a significant improvement in the haemodynamics in all patients. The technique of two-stage closure of the sternum is very effective after lengthy corrective operation in children with congenital malformations of the heart who require long periods of perfusion or ischaemia.
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Kalaria, Shana S., Joshua Henderson, and Clayton L. Moliver. "Iatrogenic Symmastia: Causes and Suggested Repair Technique." Aesthetic Surgery Journal 39, no. 8 (August 21, 2018): 863–72. http://dx.doi.org/10.1093/asj/sjy217.
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Abstract Background Various theories exist to explain the etiology of iatrogenic symmastia. Subglandular over-dissection of the medial breast pocket over the sternum, disruption of midline sternal fascia, oversized implant base diameter, and over-dissection of the medial pectoralis muscle attachments to the sternum are popular explanations. Objectives The authors hypothesized that the most common risk factor for iatrogenic symmastia is subpectoral breast augmentation. Methods A retrospective chart review was conducted including all symmastia patients who underwent surgery from January 2008 to April 2018 by a single surgeon (C.L.M.). ASAPS members were also surveyed regarding the etiology and incidence of symmastia in their practice. Results Twenty-three patients with symmastia were included in the retrospective chart review. All had previous subpectoral breast augmentation. In the ASAPS survey, 91 plastic surgeons reported seeing an average of 2.2 consults for acquired symmastia over the preceding year; 1.9 of the 2.2 (84.9%) acquired symmastia consults previously underwent subpectoral breast augmentation. Most surgeons attributed these patients’ symmastia to over-dissection of the medial pectoralis muscle attachments to the sternum. Conclusions Symmastia is most often caused by pectoralis major sternal dehiscence during subpectoral breast augmentation. In the senior author’s experience, all patients with iatrogenic symmastia previously had a submuscular breast augmentation. The ASAPS survey supports multiple causes for symmastia with retromuscular breast augmentation occurring in the majority of patients. Repair of symmastia should include securing Scarpa’s fascia to the sternum, reattaching the pectoralis major to the sternum, avoiding another subpectoral implant, and using postoperative modalities to protect the repair. Level of Evidence: 4
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Ata, Emin Can, and Metin Onur Beyaz. "Sternum Dehiscence: A Preventable Complication of Median Sternotomy." Heart Surgery Forum 23, no. 5 (August 26, 2020): E599—E605. http://dx.doi.org/10.1532/hsf.3109.
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Background: The incidence of sternal dehiscence following cardiothoracic surgery via sternotomy is rare. It causes serious patient dissatisfaction and leads to higher hospital costs. For years, each clinic has made efforts to reduce this complication. Here, we aimed to summarize our techniques to prevent dehiscence. Material: This retrospective study included two groups operated via median sternotomy from March 2009 to May 2019. The first group included 1,105 consecutive patients who only received sternum wire for sternum closure from March 2009 to October 2013. The second group included 1,559 consecutive patients operated from January 2014 to May 2019; preventive closure techniques were performed for predefined high-risk patients in this group. These closure techniques included polyglyconate (Maxon) or simple longitudinal reinforced sutures, sternal cable or sternoband, sternal plate, and Robiscek technique. Results: All patients in Group 1, and 63.8% (995/1559) patients in Group 2 received sternal wire only (P < .001). In Group 2, we applied preventive closure techniques to 564 (36.2%) patients. There was no sternal dehiscence in Group 2, whereas 29 (2.6%) patients postoperatively suffered sternal dehiscence in Group 1; this was statistically significant (P = .001, OR:85.5, 95%CI:5.22-1400.4). The overall incidence of mediastinitis was 0.94%. The incidence significantly was lower in Group 2 (P = .004, OR:3.6, 95%CI:1.52-8.82). Sternum-related mortality in Group 2 also was lower (0.54% versus 0.06%, P = .048, OR:8.5, 95% CI: 1.02-70.75). Conclusion: Sternal dehiscence can be avoided by careful perioperative risk assessment and enhanced closure techniques. The same special consideration may significantly reduce mediastinitis and sternal-related mortality.
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Soltani, Siamak, Abbas Aghabiklooei, Maryam Ameri, Azadeh Memarian, and Ali Nikanzad. "Gender Identification Based on the Parameters of the Sternum Bone in the Cadavers." International Journal of Medical Toxicology and Forensic Medicine 10, no. 1 (March 19, 2020): 26740. http://dx.doi.org/10.32598/ijmtfm.v10i1.26740.
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Background: Identifying identity in the absence of large bones becomes more difficult and complicated; accordingly, it is highly beneficial to use the features of the sternum. The present study aimed to evaluate the dimensions of the sternum and its relation with gender in the Iranian population.Methods: This cross-sectional study was conducted on 200 cadavers (100 men and 100 women). By performing an autopsy, the sternum bone was first cut in the midline using a vibrating saw, and the different dimensions were measured using a caliper.Results: Among different dimensions related to the sternum, the mean length of manubrium, mesosternum, the largest width of manubrium, and the shortest width of manubrium were significantly higher in men compared to women. Regarding the value of each sternal diameter in discriminating male and female gender, the highest discriminative value was specified to the shortest width of manubrium (cutoff: 26.75, sensitivity: 100%, specificity: 84.0%), followed by the length of sternebrae 1 (cutoff: 8.45, sensitivity: 76.0%, specificity: 21.0%).Conclusion: Measuring various indices of sternum bone, particularly the shortest width of the manubrium and the length of sternebrae 1, leads to gender identity accurately.
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Slavchev, S., and L. Lazarov. "KEEL BONE DAMAGE IN LAYING HENS – DIAGNOSTIC METHODS AND SEVERITY EVALUATION." Trakia Journal of Sciences 18, Suppl.1 (2020): 24–28. http://dx.doi.org/10.15547/tjs.2020.s.01.005.
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Modern industrial egg production is accompanied by a number of clinical problems related to the welfare of laying hens. Sternum injuries are some of the most common pathologies in this animal species. The sternum in hens is 9-12 cm long and is located in the ventral sagittal plane (1). This is the largest bone in the body of the hen and serves as the basis of the entire skeleton. Bone growth and ossification is a process that begins in the cranial part and gradually ends in the caudal part. In the early stages of the egg-laying period (between 28 and 40 weeks of age), it is not yet fully ossified, and the caudal tip often remains cartilaginous (1). This makes the sternum more vulnerable to damage than other long bones that complete their ossification in time (2). A large percentage of birds housed in aviary breeding systems are affected by sternal fractures. Due to the way chickens are raised, the sternum is affected by morphological changes that are important for animal welfare. The main concern stems from the pain experienced by laying hens with fractures and deformities of the sternum.
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Molinaro, Francesco, Alfredo Garzi, Elisa Cerchia, Vincenzo Giuseppe Di Crescenzo, Luca Luzzi, Anna Lavinia Bulotta, Giuseppe Gotti, and Mario Messina. "Sternal reconstruction by extracellular matrix: a rare case of phaces syndrome." Open Medicine 11, no. 1 (January 1, 2016): 196–99. http://dx.doi.org/10.1515/med-2016-0037.
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AbstractCongenital defects of the sternum are rare and due to a failure of midline development and fusion of the sternal bones. Surgical correction of a sternal cleft should be preferred during infancy for functional reasons. Chest wall reconstruction represented a complex problem in the last decades.We report our successful outcome of sternal reconstruction in a rare case of PHACES syndrome, in which the patient was submitted to reconstruction of the sternum and complete closure of the thoracic defect by the employ of an extracellular matrix XCM Biologic tissue matrix.We promote the use of extracellular matrix in surgical reconstruction of chest defects for its maneuverability, plasticity, tolerability and the possibility of growing with the children’s chest getting a good compliance and optimal cosmetic results.
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Hussain, Dr Hidayath. "Mediastinal Tuberculosis with Sternal Encroachment - A Rare Presentation of Tuberculosis." Journal of Medical Science and clinical Research 12, no. 01 (January 31, 2024): 44–49. http://dx.doi.org/10.18535/jmscr/v12i01.07.
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Introduction Extra-pulmonary tuberculosis constitutes 15-20% of the total tuberculosis (TB) caseload in immunocompetent patients. Affliction of the skeletal system is rare with still rarer presentation of sternal tuberculosis. Sternum is one of the least common bones of the body to get infected (1) Sternal TB is predominantly seen in middle-aged adults although no age is immune and it has also been reported in an infant. It can arise primarily due to a hematogenous route or direct extension from the hilar lymph nodes and/or could be due to lymphatic disseminatio(2) . Sternal tuberculosis has also been reported after BCG vaccination in the pediatric age group (3-5) Here we present an unusual case of tuberculosis of the sternum, which presented with swelling and pain in the chest in a 9 year old boy. Keywords: Sternal tuberculosis, Manubrium sterni, Skeletal Tuberculosis, Pediatric sternal tuberculosis, Mediastinal Koch’s
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Rothstein, William, Tyler Spata, Bryan Whitson, and Ahmet Kilic. "Multidimensional Sternal Fixation to Overcome a “Floating” Sternum." Case Reports in Surgery 2014 (2014): 1–4. http://dx.doi.org/10.1155/2014/690160.
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This case report describes the repair of a complete sternal dehiscence of the lower right sternum using sternal wires, manubrial plates, and a Talon closure device for rigid, multidimensional sternal fixation. Sternal dehiscence is a rare but significant cause of morbidity for patients undergoing median sternotomy. The risk factors for this complication are well described and although sternal wires have traditionally been used for primary closure, rigid fixation with sternal plates is a viable alternative to avoid dehiscence in this high-risk cohort.
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Heilmann, Claudia, Stefan Sorg, Matthias Mueller, Sami Kueri, Claudia Schmoor, Matthias Siepe, Friedhelm Beyersdorf, and Tetyana Leinberger. "The COSTA Study: Sternal Closure in High-Risk Patients - A Prospective Randomized Multicenter Trial." Thoracic and Cardiovascular Surgeon 66, no. 06 (February 2, 2018): 508–16. http://dx.doi.org/10.1055/s-0037-1618584.
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Background Median sternotomy in patients with risk factors for wound healing is associated with high rates of postoperative wound infections and sternum instability. Methods A total of 338 patients with elective first median sternotomy and at least four predefined risk factors were randomized between Sternal Talon (Gebrüder Martin GmbH & Co. KG—KLS Martin Group, Tuttlingen, Germany) and wire cerclage. The primary end point was mediastinitis and/or sternal instability within 30 ± 5 days, and the secondary end points were mediastinitis and/or sternal instability within 60 ± 5 days; incidence of pneumonia during hospitalization within the first 30 (±5) days and chest pain intensity. Results The primary end point was reached in 10 Sternal Talon and 7 wire cerclage patients (6.2 vs. 4.7%, odds ratio [OR]: 1.3, 95% confidence interval [CI]: 0.5–3.6, p = 0.57) from 338 randomized patients. Sternal Talon group, n = 170 patients versus wire cerclage group, n = 168 patients. The differences between treatment groups with regard to the incidence of mediastinitis/sternum instability within the first 60 (±5) days after the primary sternum closure and the incidence of pneumonia during the hospitalization within the first 30 (±5) days were not statistically significant, either. We observed comparable rates of superficial surgical site infection (SSI) in Sternal Talon and wire cerclage patients (16.1 vs. 12.1%, OR: 1.4, 95% CI: 0.7–2.7, p = 0.31). Conclusion According to these data, there is no statistically significant difference between Sternal Talon closure and wire cerclage in reducing the incidence of mediastinitis and superficial SSI after primary closure of median sternotomy in high-risk patients.
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Roth, Peter, Jenna Stella, Bernd Niemann, Philippe Grieshaber, Rainer Roehrig, and Andreas Böning. "Fibrin-Coated Collagen Fleece Seems to Prevent Sternal Instability after Cardiac Surgery: A Matched Pair Data Analysis." Thoracic and Cardiovascular Surgeon 68, no. 08 (August 28, 2018): 737–42. http://dx.doi.org/10.1055/s-0038-1667326.
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Abstract Background To examine if fibrin-coated collagen fleece (Tachosil) interferes with bone and wound healing when it is used on the cut surface of the sternum after median sternotomy. Methods A total of 25 patients with osteoporotic sternal disorders were treated with fibrin-coated collagen fleece at the cut surface of the sternum after median sternotomy (therapy group). We compared the occurrence of impaired wound healing and sternal instability, reoperation rate, and 30-day mortality with a control group of 25 case-matched patients. After matching for age, gender, and risk factors for sternal instability (diabetes mellitus, osteoporosis, body mass index, nicotine consumption), both groups were comparable. Results Sternal instability occurred in one (4%) patient in the study group and in five (20%) patients in the control group. Impaired wound healing occurred in one (4%) patient in the therapy group and two (8%) patients in the control group. Reoperation was necessary in four (16%) patients in the therapy group and 6 (24%) patients in the control group. The 30-day mortality occurred in six (24%) patients in the therapy group and four (16%) patients in the control group. Conclusions The use of fibrin-coated collagen fleece on the cut surface of the sternum in patients with osteoporosis does not impair bone and wound healing. Furthermore, it seems to result in less sternal instability. A larger prospective study is necessary to verify the results of this explorative study.
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Panfilov, D. S., E. L. Sonduev, M. S. Kuznetsov, and B. N. Kozlov. "Sternal closure in patients with the high risk of sternal dehiscence." Grekov's Bulletin of Surgery 180, no. 4 (May 20, 2021): 46–50. http://dx.doi.org/10.24884/0042-4625-2021-180-4-46-50.
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The objective was to evaluate the efficacy of sternal closure using the «double twist» technique.Methods and materials. The study included 37 patients with risk factors for sternal dehiscence (obesity, diabetes, chronic obstructive pulmonary disease). The patients were divided into 2 groups. In the first group (n=12), «double twist» technique was used. In patients of the second group (n=25), osteosynthesis was performed using standard technique (single wire ligatures). The efficacy of the «double twist» sternal closure was evaluated on the basis of clinical examination and multispiral computed tomography of the chest.Results. In the early postoperative period, the sternal dehiscence, which required re-operation was detected in 12 % after standard sternal closure. Sternum was stable in all of the patients of «double twist» group (p=0.211). No deep sternal infection was observed in both groups. In the follow-up (up to 6 months), there were no clinical and tomographic sings of delayed sternal dehiscence or infection in «double twist» group.Conclusions. Sternal closure using the «double twist» technique provides reliable fixation of the sternum in patients with the risk of its dehiscence.
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van den Broek, Dirk H. N., Siemone C. Vester, Mauricio Tobón Restrepo, and Stefanie Veraa. "Sternal Abnormalities on Thoracic Radiographs of Dogs and Cats." Animals 13, no. 7 (April 2, 2023): 1233. http://dx.doi.org/10.3390/ani13071233.
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Evaluation of the sternum is part of the routine examination of small animal thoracic radiographs. However, descriptions on frequency and type of abnormalities are lacking. This retrospective observational study aimed to describe abnormal radiographic findings of the sternum in a cross-section of client-owned dogs and cats undergoing thoracic radiography between 1 January 2019 and 1 January 2021 for reasons unrelated to diseases of the sternum. The study population consisted of 777 dogs (mean age, 7.3 ± 3.9 years) and 183 cats (mean age, 7.3 ± 5.1 years). Sternal abnormalities were observed in 189/777 (24%) dogs and 53/183 (29%) cats, mostly around the intersternebral cartilages, accounting for 32/80 (40%) dogs and 20/35 (57%) cats. This was followed by an abnormal number of sternal segments (8% dogs, range 3–9 sternebrae; 15% cats, range 7–9 sternebra). Pectus excavatum was observed in 6/777 (0.8%) dogs and 6/183 (3%) cats, and pectus carinatum in 18/777 (2%) dogs and 2/183 (1%) cats. Post-traumatic changes, such as subluxation, were observed in nine dogs (1.1%) and three cats (1.6%). Presumed prostatic carcinoma metastasis and malignant lymphoma were observed in two dogs (0.2%). Incidental radiographic sternal abnormalities are common in cats and dogs but mostly of unknown clinical relevance.
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Tricard, Jeremy, Anaëlle Chermat, Eric Denes, and François Bertin. "Antibiotic-loaded ceramic sternum for sternal replacement in a patient with deep sternal wound infection." Interactive CardioVascular and Thoracic Surgery 29, no. 6 (July 31, 2019): 973–75. http://dx.doi.org/10.1093/icvts/ivz182.
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Abstract A 68-year-old man presented with destruction of his sternum after cardiac surgery. Classical management with multiple debridements, vacuum dressings and antibiotics failed. A replacement of his sternum was performed using an antibiotic-loaded porous alumina ceramic sternum. Despite the infected wound, the ceramic sternum did not get infected due to the high antibiotic concentration obtained locally. Two years after the surgery, no relapse occurred and the pulmonary function tests improved.