Anatomical variations of the sternal angle and anomalies of adult human sterna from the Galloway osteological collection at Makerere University Anatomy Department
Abstract
Background: Anatomical variations of the sternal angle and anomalies of the sternum are unique happenings of major clinical significance. It is known that misplaced sternal angles may lead to inaccurate counting of ribs and create challenges with intercostal nerve blocks and needle thoracostomies. Sternal foramina may pose a great hazard during sternal puncture, due to inadvertent cardiac or great vessel injury. These sternal variations and anomalies are rarely reported among Africans. The aim of this study was to determine the anatomical variations of the sternal angle and anomalies of the sternum among adult dry human sterna at the Galloway osteological collection, Makerere University, Uganda.
Materials and methods: This was a descriptive cross sectional study in which quantitative and qualitative data were collected. The study examined 85 adult human sterna at the Department of Anatomy, Makerere University. Univariate and bivariate analyses were done using SPSS 21.0 for Windows.
Results: Over 40% (36/85) of the specimens had variations in size, location and fusion of the sternal angle. There was no significant difference in the mean size of the sternal angle in males at 163.4 ± 6.7o compared with 165.0 ± 6.4o in females (p = 0.481). Of the 85 specimens examined, only 21 (24.7%) had a xiphoid process. The most frequent sternal anomalies were bifid xiphoid process 42.9% (9/21) and sternal foramen 12.9% (11/85).
Conclusions: Sternal variations and anomalies are prevalent in the Galloway osteological collection and there is need for increased awareness of these findings as they may determine the accuracy of clinical and other procedures in the thoracic region.
Keywords: abnormal sternumphysical examinationsternal fracturessternal puncturesternal imaging
References
- Babinski MA, de Lemos L, Babinski MSD, et al. Frequency of sternal foramen evaluated by MDCT: a minor variation of great relevance. Surg Radiol Anat. 2015; 37(3): 287–291.
- BakamaNume, BB "Road Traffic Accidents in Uganda: Epidemiological and Transport Policy Implications, " African Social Science Review: Vol. 3: Iss 3 2006: Article 2.
- Baubin M, Rabl W, Pfeiffer KP, et al. Chest injuries after active compression-decompression cardiopulmonary resuscitation (ACD-CPR) in cadavers. Resuscitation. 1999; 43(1): 9–15.
- Cubuk S, Hamcan S. Anatomic variations of sternum may mimic traumatic complications. Am J Emerg Med. 2016; 34(9): 1912.e1–1912.e2.
- de Waele J, Calle P, Blondeel L, et al. Blunt cardiac injury in patients with isolated sternal fractures: the importance of fracture grading. Eur J Trauma. 2002; 28(3): 178–182.
- Duraikannu C, Noronha OV, Sundarrajan P. MDCT evaluation of sternal variations: Pictorial essay. Indian J Radiol Imaging. 2016; 26(2): 185–194.
- El-Busaid H, Kaisha W, Hassanali J, et al. Sternal foramina and variant xiphoid morphology in a Kenyan population. Folia Morphol. 2012; 71(1): 19–22.
- El-Busaidy H, Hassanali J, Kaisha W, et al. Prevalence of abnormal sternal angles in a Kenyan population. Anat Physiol. 2014; 4(1): 135.
- Fokin AA. Cleft sternum and sternal foramen. Chest Surg Clin N Am. 2000; 10(2): 261–276.
- Gay LR, Airasian P. Educational Research Competencies for Analysis and Application, 7th ed. Upper Saddle River, NJ: Merrill, Prentice Hall, Chapter 10 2003.
- Halvorsen TB, Anda SS, Naess AB, et al. Fatal cardiac tamponade after acupuncture through congenital sternal foramen. Lancet. 1995; 345(8958): 1175.
- Harley DP, Mena I. Cardiac and vascular sequelae of sternal fractures. J Trauma. 1986; 26(6): 553–555.
- Hills MW, Delprado AM, Deane SA. Sternal fractures: associated injuries and management. J Trauma. 1993; 35(1): 55–60.
- Jit I, Bakshi V. Time of fusion of the human mesosternum with manubrium & xiphoid process. Indian J Med Res. 1986; 83: 322–331.
- Moore KL. Thorax: Clinically Oriented Anatomy, 7th ed. Lippincott Williams and Wilkins, Philadelphia 2013: 41–42.
- Ochieng J, Ibingira CBR. Sternal Anomalies with Supernumerary and Subnumerary Vertebrae and Ribs Case Reports. Association of Surgeons of East Africa and College of Surgeons of East Central and Southern Africa. 2007; 12(1): 99–104.
- Parikh CK. Parikh’s Textbook of Medical Jurispendence and Toxicology, . Medical Publications 2005: 2.9–2.10.
- Pattimore D, Thomas P, Dave SH. Torso injury patterns and mechanisms in car crashes: an additional diagnostic tool. Injury. 1992; 23(2): 123–126.
- Pevenage P, Maeseneer M, Muylle K, et al. Sternal foramen simulating osteolytic lesion on scintigraphy and SPET imaging. Ann Nucl Med Sci. 2002; 15: 227–230.
- Reddy KSN. The Essentials of Forensic Medicine and Toxicology. Medical Book Company 2006: 25, 67.
- Selthofer R, Nikolić V, Mrcela T, et al. Morphometric analysis of the sternum. Coll Antropol. 2006; 30(1): 43–47.
- Singh D, Jit I. Sanjeev Time of fusion of mesosternum with manubrium and xiphoid process. J Ant Soc India. 1994; 43: 125–135.
- Singh TB, Singh C, Fimate L. Age determination from the degree of fusion of manubrio-mesosternal joint. J Forensic Med Toxicol. 2004; 21(1): 15–18.
- Skandalakis J, Colborn G, Weidman T, et al. Thoracic wall and pleura: Skandalakis Surgical Anatomy, McGraw-Hill, Chapter 2, 2006.
- Wadhawan M, Murari A, Murali G. Estimation of age from the fusion of mesosternum with manubrium and xiphisternum in Delhi: A comparative study. J Indian Acad Forensic Med. 2009; 31(2): 103–6.
- Wolochow MS. Fatal cardiac tamponade through congenital sternal foramen. Lancet. 1995; 346(8972): 442.
- Yekeler E, Tunaci M, Tunaci A, et al. Frequency of sternal variations and anomalies evaluated by MDCT. AJR Am J Roentgenol. 2006; 186(4): 956–960.
