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The sternum can be affected by two congenital abnormalities from defective fusion: a sternal foramen, which is relatively common, and a (longitudinal) sternal cleft which is rarer. This case shows both a foramen and a small cleft, together making a keyhole-shaped defect. It was observed in a human skeleton coming from North-Eastern Italy and dating back to between the 16th and 17th century AD. CT reveals the incidence of clefts in the manubrium to be 0.6%, and in the body 0.8%; xiphoidal clefts occur in 1.9%. Sternal foramina are found in 4–8% of adults. This information is highly relevant to performing acupuncture in this region. The skin to heart distance can be as little as 10 mm in lean individuals. Large foramina and clefts will be identifiable by careful palpation, in which case do not insert a needle. If you cannot palpate a defect, a small one may be present: so always insert the needle at a shallow angle.

Image and information kindly provided by Luciana Travan, Section of Anatomy, Department of Experimental and Clinical Medicine, University of Udine Medical School, Udine, Italy.

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