title: Sternal foramina and variant xiphoid morphology in a Kenyan population.
abstract: Sternal foramina may pose a great hazard during sternal puncture, due to inadvertent cardiac or great vessel injury. They can also be misinterpreted as osteolytic lesions in cross-sectional imaging of the sternum. On the other hand, variant xiphoid morphology such as bifid, duplicated, or trifurcated may be mistaken for fractures during imaging. The distribution of these anomalies differs between populations, but data  from Africans is scarcely reported. This study therefore aimed to investigate the distribution  and frequency of sternal foramina and variant xiphoid morphology in a Kenyan  population. Eighty formalin-fixed adult sterna (42 males [M], 38 females [F]) of  age range 18-45 years were studied during dissection at the Department of Human Anatomy, University of Nairobi. Soft tissues were removed from the macerated sterna by blunt dissection and foramina recorded in the manubrium, body, and xiphoid process. The xiphisternal ending was classified as single, bifurcated (2 xiphoid processes  with a common stem), or duplicated (2 xiphoid processes with separate stems).  Results were analysed using SPSS version 17.0. Foramina were present in 11 specimens (13.8%): 7 M, 4 F. The highest frequency was in the sternal body (n = 9), where they predominantly occurred at the 5th intercostal segment. Xiphoid foramina were present in 2 specimens (both males) (2.5%), while manubrial foramen was not  encountered. The xiphisternum ended as a single process in 64 cases (34 M, 30 F) (80%). It bifurcated in 10 cases (5 M, 5 F) (12.5%), and duplicated in 6 cases (4 M, 2 F) (7.5%). There were no cases of trifurcation. Sternal foramina in Kenyans vary in distribution and show higher frequency than in other populations. These variations may complicate sternal puncture, and due caution is recommended. The variant  xiphisternal morphology may raise alarm for xiphoid fractures and may therefore be considered a differential.
authors.affiliation: Department of Human Anatomy, University of Nairobi, Kenya. elhemed@gmail.com
authors.forename: H
authors.initials: H
authors.lastname: El-Busaid
authors.forename: W
authors.initials: W
authors.lastname: Kaisha
authors.forename: J
authors.initials: J
authors.lastname: Hassanali
authors.forename: S
authors.initials: S
authors.lastname: Hassan
authors.forename: J
authors.initials: J
authors.lastname: Ogeng'o
authors.forename: P
authors.initials: P
authors.lastname: Mandela
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People / Q000235:genetics*; D002102:Cadaver; D005260:Female; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D009139:Musculoskeletal Abnormalities / Q000453:epidemiology / Q000235:genetics / Q000473:pathology*; D013249:Sternum / Q000002:abnormalities* / Q000601:surgery; D014989:Xiphoid Bone / Q000002:abnormalities* / Q000601:surgery; D055815:Young Adult