The sternum is a flat, dagger-shaped bone forming the anterior midline of the thorax, consisting of the manubrium, body, and xiphoid process. It articulates with the clavicles and ribs 1-7 via costal cartilages and provides attachment for pectoral and sternal muscles.
| Articulations |
|
|---|---|
| Landmarks |
|
| Ossification | Multiple membranous centres for the manubrium and body sternal bars fusing in the midline. The xiphoid remains cartilaginous until age 40. |
The sternal angle of Louis at the manubriosternal junction marks the T4-T5 level, second rib insertion, aortic arch, carina bifurcation, and superior vena cava beginning, the most clinically useful landmark in the thorax. Median sternotomy for cardiac surgery splits the sternum and is closed with sternal wires. Sternal fractures from steering wheel impact or direct blow require cardiac monitoring for myocardial contusion. Sternal wound infections after cardiac surgery are serious complications requiring debridement and flap reconstruction.
Usually caused by steering wheel or seat belt impact in vehicle collisions; it is painful and may indicate underlying blunt cardiac injury.
After median sternotomy for heart surgery, the sternum may fail to heal or become infected, causing instability and a clicking chest wall.
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