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Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation: Opus V: Skeletal System: Sternum

Illustrated Encyclopedia of Human Anatomic Variation: Opus V: Skeletal Systems: Thorax


Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD

Peer Review Status: Internally Peer Reviewed

The two lateral halves of the sternum may fail to unite and thereby form a cleft sternum (so-called fissura sterni). In other cases, the union of the two halves occurs in the manubrial region but fails distally. The cranial and caudal parts may be fused but the intermediate part remains separate. The failure to fuse can be very slight or very extensive and is sometimes accompanied by ectopia cordis.

A more common variation in the sternum is asymmetry of the costal cartilages, which may articulate in an alternating pattern.

Cartilaginous nodules or suprasternal ossicles may occur singly or paired at the superior margin of the manubrium. The frequency of occurrence is reported to be 6-7% of cadavers studied. By x-ray examination, Cobb found separate or fused suprasternal bones in 6.8% of adult whites and in 2.2% of adult Negroes; the highest incidence, 7.6%, was in white females.

The joint between the manubrium and the body of the sternum may become ossified. The manubrium sometimes extends to the insertion of the third costal cartilages. This usually occurs in gibbons and occasionally in other anthropoid apes.

The body of the sternum may be perforated, usually at its lower end.

The xiphoid process is typically variable in size and shape (it may be cleft) and may be absent. An abnormally long xiphoid, extending to a level of the umbilicus, has been reported. The xiphoid process may be perforated, more frequently than is the body of the sternum.

The body of the male sternum is relatively longer than that of the female; in males it is more than twice the length of the manubrium whereas in females it is usually less than twice the length.

Agenesis of the sternum in viable children is rare.

Fissura Sterna.

Variations in Sternum. Suprasternal Bones. Bifid Xiphoid Process. Apertures in Body of Sternum and in Xiphoid Process.

Variations in Suprasternal Bones.

Variations of Sternum and Associated Structures


Abbott, J. (1852) Absence de sternum chez une femme adulte; compatibilté de cette anomalie avec la vie et la santé. Soc. Biol. Comptes Rendus des Séances et Mémoires 4:163.

Ashley, G.T. (1956) The relationship between the pattern of ossification and the definitive stage of the mesosternum in man. J. Anat. 90:87-105.

Bánki, Z. (1965) Über den Processus costalis sterni. Fortschr. Röntgenstr. 102:518-522.

Bernardo, G.F. (1898) A case of ectopia cordis c. fissura sterni. J. Anat. Physiol. 32:325-333.

Buchanan, A.M. (1894) Abnormal sternum. J. Anat. Physiol. 28:313-314.

Burton, J.F. (1944) Congenital defects of the sternum. Oklahoma State Med. Assn. J. 37:210-212.

Burton, J.F. (1947) Method of correction of ectopia cordis. Arch. Surg. 54:79-84.

Carwardine, T. (1893) The suprasternal bones in man. J. Anat. Physiol. 27:232-234.

Chang, C.H. and W.C. Davis. (1961) Congenital bifid sternum with partial ectopia cordis. Am. J. Roentgenol. 86:513-516.

Cobb, W.M. (1936-37) The ossa suprasternalia in whites and American negros and the form of the superior border of the manubrium sterni. J. Anat. 71:245-291.

Colosimo, C. (1939) Xifosterno bifurcuto e abnormente lungo. Radiol. Med. (Torino) 26:42-43.

De Cuveland, E. (1956) Über das sogenannte Os parasternale. Fortschr. Röntgenstr. 84:375-376.

Dukes, L. and S.A. Owen. (1902) Anomalies in the cervical and upper thoracic region, involving the cervical vertebrae, first rib, and brachial plexus. J. Anat. Physiol. 36:290-291.

Elias, H. (1918) Ein Fall von Fissura sternalis congenita completa simplex. Wien. Klin. Wochenschr. 31:98-100.

Etter, L.E. (1944) Osseous abnormalities of the thoracic cage seen in forty thousand consecutive chest photoroentgenograms. Am. J. Roentgenol. 51:359-363.

Gibson, G.A. and H. Malet. (1879) Presternal fissure uncovering the base of the heart. J. Anat. Physiol. 14:1-9.

Greig, D.M. (1926) Cleft-sternum and ectopia cordis. Edinb. Med. J. 33:480-511.

Herdner, -. (1947) Le sternum de l'enfant. Fréquence actuelle de troubles de dévelopment révélés par l'examen radiographique. J. Radiol. Electrol. 28:387-393.

Herdner, M. (1947) Le sternum de l'enfant étude radiologique des anomalies de son dévelopment. Rev. Orthop. 33:475-493.

Hyman, C. (1947) Congenital defect of the sternum with congenital heart disease. J. Med. Soc. NJ. 44:355-356.

Kipshoven, H.J. (1951) Die rontgenologishe Darstellung der Ossa suprasternalia. Fortschr. Rontgenstr. 74:320-323.

Knight, G.A.M. and G.H. Morley (1936-37) Cleft sternum: case report and brief commentary. Brit J. Surg. 24:60-64.

Krontiris, A. and A. Tsironis. (1964) Bifid stemum:Successful repair by use of an acrylic plaque: Report of a case. J.Internat.Coll. Surg. 41:301-307.

Larsen, L.L. and H.F. Ibach. (1962) Complete congenital fissure of the sternum. Am. J. Roentgenol. 87:1062-1963.

Lickley, J.D. (1904) On the relations of the seventh and eighth ribs to the sternum. Anat. Anz. 24:326-331.

Maier, H.C. and F. Bortone. (1949) Complete failure of sternal fusion with herniation of pericardium: Report of a case corrected surgically in infancy. J. Thoracic Surg. 18:851-859.

Morris, H. (1940) Suprasternal bones demonstrated in the living subject. Brit. J. Radiol. 13:356.

Murray, G. (1951) Surgical treatment of funnel sternum. Am. J. Surg. 82:144-148.

Nègre, A. (1952) Ossicules suprasternaux. J. Radiol. Electrol. 33:537.

Obermeier, A. (1869) Eine unvollständige Brustbeinspalte. Arch. Pathol. Anat. Physiol. Klin. Med. 46:209-217.

Pansch, A. (1875) Ueber Anomlien aur Thoraxskelete. Arch. f. Anatomi. Physiol. u. Wissen. Med. 1875:552-564.

Pfeiffer, K. (1956) Variationen und Anomalien des Brustbeines sowie Hinweise zu deren Entwicklung. Fortschr. Röntgenstr. 85:663-671.

Ramos, A. and A.S. Tavares (1956) Quelques aspects de la morphologie du sternum (a propos de deux observations radiologiques d'os supra-sternaux). Assoc. Anatomistes Comptes Rendus 43:717-735.

Ravelli, A. (1956) Das Ossiculum parasternale. Fortschr. Röntgenstr. 85:226-231.

Schoberth, H. (1961) Die Trichterbrust. Ergeb. Chir. Orthop. 43:122-202.

Seitz, C. (1884) Eine seltene Missbildung des Thorax. Arch. Pathol. Anat. Physiol. Klin. Med. 98:335-337.

Sutherland, I.D. (1958) Funnel chests. J. Bone Joint Surg. (Br.) 40:224-251.

Trotter, M. (1934) Synostosis between manubrium and body of the sternum in whites and negroes. Am. J. Physiol. Anthropol. 18:439-442.

Turner, W. (1879) A description of cleft sternum. J. Anat. Physiol. 14:103-106.

Wanstrom, R.C. (1936) Fissura sterni with ectopic cordis. J. Tech. Methods 16:88-93.

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