High Prevalence of Sternal Foramen: Quantitative, Anatomical Analysis and its Clinical Implications in Acupuncture Practice

Abstract

SUMMARY:The aim of our study was to verify the prevalence of the sternal foramen in adult cadavers and dry bones, as well as to determine its exact localization and relation to acupuncture points. One hundred eighty sternums fixed and contained in 10% formaldehyde solution were examined, of which 100 were dry bones and 80 belonged to adult cadavers. The morphometric measures were expressed in millimeters when measuring the length: 1) from jugular incision to the foramen (JI-F); 2) from sternal angle to the foramen (EA-F); 3) from xiphoid process to the foramen (XP-F). Statistical analysis was performed to compare expected vs obtained foramina frequency, using Fisher's test (p≤0.05 was considered significant). The results showed 16.6% sternal foramina, significant higher than expected (p≤0.0248). Of the 30 foramina, 53.3% were found in cadavers, of which one was a woman, and 46.7% sternums were found in dry bones. Of the cadavers with sternal foramen, 10 foramina were at the 5th sternochondral articulation level and 6 foramina at the 4th sternochondral level. Of the 14 analyzed dry bones, 9 foramina were at the space between the 4th and the 5th costal pit level and 5 foramina were at the 5th costal pit level. The mean±SD (mm) total length of the sternums was 151.8±34 and the measures JI-F, EA-F, and XP-F were, respectively, 103.8±22.1mm, 65.6±15mm and 46.9 ±15mm. Knowledge of this occurrence is important to avoid serious heart injury by needle insertion, especially as this area holds a commonly used acupuncture point and sternal puncture.

Morphological approach of the sternal foramen: an anatomic study and a short review of the literature

“…Reported incidence ranges from 0.06% to 18.3%. Prevalence of SF is reported from 0.06% up to 11.6% in radiological studies [4,5,8,18,20,24,26,30], 6.7% to 16.6% in cadaveric studies [3,9,19], and 13.8% and 18.3% in the 2 published anatomic studies, conducted in dry specimens [12,21]. SFs were observed in 5 of 35 sterna (14.6% of dried specimens) in the present study.…”

Anatomical and congenital variations of human dry sternum bone: its embryogenesis and clinical implications

“…They have been reported in manubrium, body and xiphisternum. Stark et al reported 4.3% incidence of sternal foramen on chest CT, 6.7% in autopsy cases by Cooper,6.6% by Moore et al, 5.1% in Turkish population by Aktan et al, and 16.6% in cadavers and dry bones by Babinski et al [5][6][7][8][9] Where as in our study we observed 14% of sternal foramen in the body of sternum. The size of sternal foramina ranged between 2 and 16mm, with mean of 6.5mm; Jitender Kumar et al reported sternal foramen with a length of 18.75mm and width 12.50mm.…”

Evaluation of the morphological characteristic and sex differences of sternum by multi-detector computed tomography

“…In our study, none of the subjects had a foramen in the Manubrium. Babinski et al [5] reported a higher prevalence of 16.6%. Akin et al [10] Determined that xiphoidal foramen was present in 216 patients (43.2%); 171 patients (34.2%) had only one foramen; 31 patients (6.2%) had two, seven patients (1.4%) had three, and seven patients (1.4%) had four or more xiphoidal foramina.…”

“…Sternal morphological measurement is greatly important in anthropological research, clinical, and surgical approach. The largest series evaluating the Sternal Morphometric analysis, Sternal variations and anomalies were based on the Macroscopic and Radiographic appearances of the sternum in autopsy populations [1][2][3][4][5]. Sternal variations and anomalies represent congenital anatomic defects, occurring as a result of an impaired and incomplete ossification center fusion [6,7].…”