The clavicle gives support to the shoulder girdle by acting as a strut between scapula and sternum. The body of the sternum is found at the level of T5-T9 vertebrae. PLoS One 10, 1–33 (2015). However, too much force cannot be handled by the sternum and that is where fracture and dislocation set in. Updated December 9, 2018. On physical examination, there is local tenderness, ecchymosis, and sometimes a peculiar concavity or paradoxical respiratory movement, but the sternal segments usually are well aligned, without much displacement. Pectoralis major, a limb muscle, inserts on the sternal bars, so in the CF context the sternum is modelled as a ventral component of the pectoral girdle just as the scapula is a lateral/dorsal element. The most common injury identified in this report was an isolated anterior cortical fracture.11. The sternum connects the first six ribs in the middle of the chest while serving as a strong protector of the stomach, heart, and lungs which lie below. The ribs and sternum make up what is called the 'ribcage.' ), The Secret Science of Solving Crossword Puzzles, Racist Phrases to Remove From Your Mental Lexicon. The thickness of the cortex here varies from 0.2 mm to 5.0 mm, so it may be difficult to be certain that the needle point has reached the cavity of the bone. The smallest and most inferior region of the sternum, the xiphoid process, begins life as a region of flexible hyaline cartilage attached to the end of the body of the sternum. It is also the center around which the superior 10 ribs directly or indirectly attached. There may be a sensation of a “popping” sternum in sternal fracture. A broken xiphoid process followed by continued CPR can cause this sharp portion of the sternum to penetrate one of the underlying organs, which can lead to a damaged liver, spleen, heart, and/or diaphragm., When the rib cartilage that connects with the sternum becomes inflamed, this pain can be local to the sternal area or can spread to the arms or shoulders in severe cases. Image Source: paradoja7.com, Picture 5: Anterior View of the Sternum Learn the Scary Facts About Kneecap Fractures, The Difference Between Bruised, Broken, and Fractured Ribs, Chronic Pain Syndromes After Lung Cancer Surgery, Traction for Treating Fractures or Broken Bones. The sternal defect, if partial, involves the upper sternum and manubrium, in contrast with the sternal defect in thoracic or thoracoabdominal ectopia cordis, in which partial defects involve primarily the lower sternum. To obtain a bone marrow biopsy, a large bore needle is introduced into the sternum and a sample is aspirated [4]. Image Source: Clinical Anatomy 2nd edition, Picture 7:  The first sternocostal joint is categorized as synchondrosis. A sternum appears in certain salamanders; The xiphoid process specifically acts as an insertion point for the tendons of the diaphragm, rectus abdominis, and transverse abdominis muscles. The sternal segments are typically well aligned without much displacement. Jason DelCollo, DO, board-certified in family medicine. Prim Care. Puncture of the sternum must be performed with care to avoid pushing the aspiration needle through the bone. Injury to the collarbone may cause the sternum to swell, ache, pop, or click with significant movement. Radiographic demonstration of fractures is most commonly by chest x-ray or CT scan, although ultrasound is being used more frequently with high sensitivity/specificity.13, Children with traumatic injury of the sternum should be admitted to the intensive care unit given the increased risk for arrhythmias. Aspiration is then carried out as described earlier. If the sternum does not fuse, breathing is dramatically compromised. Overview and management of sternal wound infection. The anterior surface of the sternal body is almost flat. It serves as a landmark for: The sternum is a hematopoietic tissue, meaning blood cells are produced in this site. The inferior border is the narrowest part of the manubrium and it articulates with the xiphoid process through the xiphisternal joint which lies at the level of the 9th thoracic vertebra. ©1996-2020 MedicineNet, Inc. All rights reserved. The sternum consists of three parts: the manubrium (the upper segment of the sternum, a flattened, roughly triangular bone), the corpus (body) of the sternum, and the xiphoid process (the little tail of the sternum than points down). Sternal fracture is a form of a simple thoracic cage injury. Its parts are the manubrium (green), body (blue), and xiphoid process (violet). Markedly displaced fragments are reduced under general anesthesia by a closed or open technique in order to prevent a traumatic pectus excavatum. The inferior border gives rise to the linea alba. Robert E. The insertion of the coracoclavicular ligament is of practical importance. 2011;25(1):25-33. doi:10.1055/s-0031-1275168, El-Ansary D, Lapier TK, Adams J, et al. If the sternum is broken, common sense will tell that pain results. The sternum or breastbone is a vertical flat bone lying at the anterior middle part of the chest. It is found laterally on the inferior aspect of the clavicle, and just medial to it is the origin of the subclavius muscle. The succeeding joints are symphysis. Xiphoid process may be small but it is an important landmark for the structures beneath it. These muscles need explaining. The sternum, or breastbone, functions at its upper end to connect the shoulder girdle (clavicle and scapula) to the thorax. Phillip Beach DO DAc OSNZ, in Muscles and Meridians, 2010. The sternum is the bone that lies in the anterior midline of our thorax.It forms part of the rib cage and the anterior-most part of the thorax. Ludwig Ombregt MD, in A System of Orthopaedic Medicine (Third Edition), 2013. The anterior surface is where the anterior costoxiphoid ligament and a part of rectus abdominis are attached. Various materials can be used in this capacity, including autogenous tissue (rib grafts, fascia, large muscle flaps), synthetic compounds (Teflon, Prolene mesh, Gore-Tex), and composite mesh (Marlex–methylmethacrylate composite). Int J Anat Res. Anatomy Images: Where is the Sternum Located? The sternum also acts as a joining structure to the upper ribs on either side of the body. Costal cartilages nor ribs are attached to it. 2014;2:340-343. If the bony deformity is minimal, appropriate posture will suffice. Measuring around 6 inches, the sternum has three main parts: The sternum as a whole has been compared to an upside-down sword due to the rectangular part at the top resembling a handle. We use cookies to help provide and enhance our service and tailor content and ads. Children with traumatic injury of the sternum should be admitted to the intensive care unit given the increased risk for arrhythmias. It connects to the ribs via cartilage and forms the front of the rib cage, thus helping to protect the heart, lungs, and major blood vessels from injury. 62-21). However, cartilaginous connectors between the sternum and each of the upper six ribs assist with minor motions that occur with each breath. Copyright © 2020 Elsevier B.V. or its licensors or contributors. If the bony deformity is minimal, there is no specific treatment indicated. This provides a safe environment for your heart and lungs. The lateral sides of the superior border of the sternum articulate with the clavicles via sternoclavicular joints. Anderson BW, Burns B. Anatomy, thorax, xiphoid process. Ventrites are externally visible sternites. Cardiac tamponade and blunt myocardial damage must be ruled out by various studies, including serial electrocardiography, echocardiography, and careful monitoring of venous blood pressure. The adult length of the sternum measures 15-17 cm. The first complete repair of a cleft sternum was accomplished by placing a cartilage graft from the costal arch over the defect.169. If the guard cannot be advanced to this extent, it is not safe to proceed. Effects of combined chest expansion and breathing exercises in a patient with sternal pain. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. and gastroesophageal reflux disorder (GERD), Xiphoid foramen and its clinical implication, Morphological approach of the sternal foramen: an anatomic study and a short review of the literature, Effects of combined chest expansion and breathing exercises in a patient with sternal pain, Evaluation and treatment of musculoskeletal chest pain, Overview and management of sternal wound infection, An evidence-based perspective on movement and activity following median sternotomy. Subsequent methods have included bilateral oblique incisions through the costal cartilages to produce greater length and allow midline approximation of the sternal halves (sliding chondrotomies of Sabiston171; division of the cartilages laterally, swinging them medially to cover the defect (door-wing plasty of Meissner)172; rotation of the posterior sternal perichondrium to close the medial defect, followed by chondral grafts173; coverage with various autologous grafts (costal cartilage, rib, parietal skull); and coverage with prosthetic materials. Each inward breath requires the lungs to fill with air and the intercostal (or rib) muscles to contract. 2009;80(6):617-620. Phylogeny of Kinorhyncha based on morphology and two molecular loci. Several distinct somatic associations are seen, including bandlike scars extending from the umbilicus to the inferior aspect of the sternal defect. It lies on the anterior thoracic wall in the middle. It lies at the level of T10 vertebra. To deal with sternum pain, nerve block is performed wherein the intercostal nerve that transmits pain signals to the brain is being anesthetized [6]. In spiders, the sternum is the ventral part of the cephalothorax. This is the depressed part that can be palpated in between the clavicles. The lateral borders are connected with abdominal aponeuroses [, The anatomical end for anterior thoracic cage, Formation of infrasternal or subcostal angle together with the subcostal margins. Image Source: Netter’s Clinical Anatomy 2nd edition, Saunders, 2010. Note that the encircling ribs are derived from vertebral elements whereas the sternal bars are not. Other children have superior scarlike extensions to the neck or mandible; rarely, a split mandible occurs (gnathoschisis). J Phys Ther Sci. Kumar NS, Bravian D, More AB. This bone is sometimes cracked during cardiopulmonary resuscitation (CPR) as part of the sternum is located directly above the heart. Repair is performed to provide protective coverage for the heart. Fracture of the sternum may also be associated with fracture of the thoracic vertebrae [3, 5]. Published by Dr. Jackie Te RN, MD under Anatomy and Body, Pain Management. Embryologically, two cartilaginous sternal bars emerge in the space between the ribs. Picture 10:  Thoracic Cage Injuries The ventral domain courses over and embeds the costal cartilages, and the muscles found between the costal cartilages – the parasternal interchondral muscles. The shape of the bone resembles a sword in vertical position with the point downward. The sternum articulates (comes together) with the cartilages of the first seven ribs and with the clavicle (collarbone) on either side. At birth until young adulthood, there are four sternebrae attached to sternal synchondroses. 62-20). The surrounding anatomical structures are attached to it. Xiphoid foramen and its clinical implication. The joint capsules of both the sternoclavicular and the acromioclavicular joints are reinforced by several ligaments. On its lower end is the origin of the transversus thoracis. "sterna") is the ventral portion of a segment of an arthropod thorax or abdomen.. Gkantsinikoudis N, Chaniotakis C, Gkasdaris G, Georgiou N, Kapetanakis S. Morphological approach of the sternal foramen: an anatomic study and a short review of the literature. 2017;76(3):484-490. doi:10.5603/FM.a2017.0006, Khoriati AA, Rajakulasingam R, Shah R. Sternal fractures and their management.