{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:56:06Z","timestamp":1753880166788,"version":"3.41.2"},"reference-count":31,"publisher":"ASME International","issue":"11","license":[{"start":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T00:00:00Z","timestamp":1693785600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.asme.org\/publications-submissions\/publishing-information\/legal-policies"}],"funder":[{"DOI":"10.13039\/100006338","name":"Zimmer","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100006338","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["asmedigitalcollection.asme.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Understanding the force-deflection behavior of the sternum is an important element in designing devices for implants for chest wall deformity repair. Human growth and variability makes a single measure of the stiffness difficult to determine. This work takes empirical data from the literature to develop aggregate sternal force-deflection models. Statistical methods were used to determine possible groupings based on patient age and the effect of gender. It was found that three age groups could be used, representing childhood (4\u201310\u2009years), adolescence (11\u201319\u2009years), and adulthood (26\u201353\u2009years). Gender was found to have a statistical p-value of 0.068, 0.0611, and 0.012, respectively, in the proposed age groups. Jittering of the data was used to account for human variability and assumptions made in data comparisons. The jittered results followed that of the initial dataset. Childhood force-deflection behavior follows a relatively constant stiffness, adolescence experiences a growth period of increasing stiffness, and adulthood stiffnesses again begin to stabilize around a relatively constant value.<\/jats:p>","DOI":"10.1115\/1.4063148","type":"journal-article","created":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T14:33:10Z","timestamp":1691764390000},"update-policy":"https:\/\/doi.org\/10.1115\/crossmarkpolicy-asme","source":"Crossref","is-referenced-by-count":0,"title":["An Aggregate Sternal Force-Deflection Model"],"prefix":"10.1115","volume":"145","author":[{"given":"Brandon","family":"Sargent","sequence":"first","affiliation":[{"name":"Department of Mechanical Engineering, Gonzaga University, Spokane, WA 99258"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Bolanos","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor","family":"Garcia","sequence":"additional","affiliation":[{"name":"Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8132-8822","authenticated-orcid":false,"given":"Larry","family":"Howell","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"33","published-online":{"date-parts":[[2023,9,4]]},"reference":[{"issue":"10","key":"2023090510145817600_bib1","doi-asserted-by":"crossref","first-page":"101009","DOI":"10.1115\/1.4054412","article-title":"Development of a Strain-Based Model to Predict Eviscerated Thoracic Response From Dynamic Individual Rib Tests","volume":"144","year":"2022","journal-title":"ASME J. Biomech. Eng."},{"key":"2023090510145817600_bib2","doi-asserted-by":"crossref","first-page":"103742","DOI":"10.1016\/j.jmbbm.2020.103742","article-title":"Generic Finite Element Models of Human Ribs, Developed and Validated for Stiffness and Strain Prediction\u2013to Be Used in Rib Fracture Risk Evaluation for the Human Population in Vehicle Crashes","volume":"106","year":"2020","journal-title":"J. Mech. Behav. Biomed. Mater."},{"issue":"10","key":"2023090510145817600_bib3","doi-asserted-by":"crossref","first-page":"101004","DOI":"10.1115\/1.4054346","article-title":"Thorax Dynamic Modeling and Biomechanical Analysis of Chest Breathing in Supine Lying Position","volume":"144","year":"2022","journal-title":"ASME J. Biomech. Eng."},{"issue":"3","key":"2023090510145817600_bib4","doi-asserted-by":"crossref","first-page":"031007","DOI":"10.1115\/1.4048644","article-title":"Assessment of Thorax Finite Element Model Response for Behind Armor Blunt Trauma Impact Loading Using an Epidemiological Database","volume":"143","year":"2021","journal-title":"ASME J. Biomech. Eng."},{"issue":"6","key":"2023090510145817600_bib5","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1016\/j.jtcvs.2006.08.023","article-title":"Forces to Be Overcome in Correction of Pectus Excavatum","volume":"132","year":"2006","journal-title":"J. Thorac. Cardiovasc. Surg."},{"issue":"4","key":"2023090510145817600_bib6","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/S1072-7515(02)01245-0","article-title":"Force Required to Elevate the Sternum of Pectus Excavatum Patients","volume":"195","year":"2002","journal-title":"J. Am. Coll. Surg."},{"issue":"5","key":"2023090510145817600_bib7","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1089\/lap.2005.15.478","article-title":"Determination of the Mechanical Requirements for a Progressive Correction System of Pectus Excavatum in Children","volume":"15","year":"2005","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"issue":"7","key":"2023090510145817600_bib8","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1016\/j.clinbiomech.2008.02.010","article-title":"Preliminary Analysis of the Forces on the Thoracic Cage of Patients With Pectus Excavatum After the Nuss Procedure","volume":"23","year":"2008","journal-title":"Clin. Biomech."},{"issue":"2","key":"2023090510145817600_bib9","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1115\/1.2894121","article-title":"Sternal Force-Displacement Relationship During Cardiopulmonary Resuscitation","volume":"115","year":"1993","journal-title":"ASME J. Biomech. Eng."},{"issue":"9","key":"2023090510145817600_bib10","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1007\/s11517-013-1070-5","article-title":"Quantitative Geometric Analysis of Rib, Costal Cartilage and Sternum From Childhood to Teenagehood","volume":"51","year":"2013","journal-title":"Med. Biol. Eng. Comput."},{"issue":"2","key":"2023090510145817600_bib11","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1111\/joa.12203","article-title":"Morphometric Analysis of Variation in the Ribs With Age and Sex","volume":"225","year":"2014","journal-title":"J. Anat."},{"issue":"7","key":"2023090510145817600_bib12","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1016\/j.jbiomech.2008.02.006","article-title":"Quantification of Age-Related Shape Change of the Human Rib Cage Through Geometric Morphometrics","volume":"41","year":"2008","journal-title":"J. Biomech."},{"issue":"12","key":"2023090510145817600_bib13","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1016\/S0022-3468(88)80335-X","article-title":"Surgical Management of Children and Young Adults With Marfan Syndrome and Pectus Excavatum","volume":"23","year":"1988","journal-title":"J. Pediatr. Surg."},{"issue":"2","key":"2023090510145817600_bib14","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1053\/jpsu.2001.20707","article-title":"Pectus Excavatum Repair: Experience With Standard and Minimal Invasive Techniques","volume":"36","year":"2001","journal-title":"J. Pediatr. Surg."},{"issue":"3","key":"2023090510145817600_bib15","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1016\/j.athoracsur.2021.07.051","article-title":"The Severity of Pectus Excavatum Defect is Associated With Impaired Cardiopulmonary Function","volume":"114","year":"2022","journal-title":"Ann. Thorac. Surg."},{"issue":"4","key":"2023090510145817600_bib16","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/S0022-3468(98)90314-1","article-title":"A 10-Year Review of a Minimally Invasive Technique for the Correction of Pectus Excavatum","volume":"33","year":"1998","journal-title":"J. Pediatr. Surg."},{"issue":"10","key":"2023090510145817600_bib17","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1016\/S0022-3468(87)80585-7","article-title":"Use of ct Scans in Selection of Patients for Pectusexcavatum Surgery: A Preliminary Report","volume":"22","year":"1987","journal-title":"J. Pediatr. Surg."},{"issue":"12","key":"2023090510145817600_bib18","doi-asserted-by":"crossref","first-page":"2270","DOI":"10.1016\/j.jpedsurg.2011.09.009","article-title":"A Novel Measure for Pectus Excavatum: The Correction Index","volume":"46","year":"2011","journal-title":"J. Pediatr. Surg."},{"issue":"4","key":"2023090510145817600_bib19","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1007\/s00247-003-1116-1","article-title":"Age-Related Normal Ranges for the Haller Index in Children","volume":"34","year":"2004","journal-title":"Pediatr. Radiol."},{"issue":"4","key":"2023090510145817600_bib20","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1016\/j.athoracsur.2013.12.050","article-title":"The Correction Index: Setting the Standard for Recommending Operative Repair of Pectus Excavatum","volume":"97","year":"2014","journal-title":"Ann. Thorac. Surg."},{"issue":"5","key":"2023090510145817600_bib21","doi-asserted-by":"crossref","first-page":"434","DOI":"10.21037\/acs.2016.08.04","article-title":"The Sandwich Technique for Repair of Pectus Carinatum and Excavatum\/Carinatum Complex","volume":"5","year":"2016","journal-title":"Ann. Cardiothorac. Surg."},{"issue":"2","key":"2023090510145817600_bib22","doi-asserted-by":"crossref","first-page":"92","DOI":"10.5090\/kjtcs.2016.49.2.92","article-title":"Minimally Invasive Repair of Pectus Carinatum in Patients Unsuited to Bracing Therapy","volume":"49","year":"2016","journal-title":"Korean J. Thorac. Cardiovasc. Surg."},{"issue":"3","key":"2023090510145817600_bib23","doi-asserted-by":"crossref","first-page":"e228","DOI":"10.1093\/ejcts\/ezt345","article-title":"Pectus Carinatum: The Effects of Orthotic Bracing on Pulmonary Function and Gradual Compression on Patient Compliance","volume":"44","year":"2013","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"issue":"1","key":"2023090510145817600_bib24","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s00383-013-3419-0","article-title":"Minimal Invasive Extrathoracic Presternal Compression Using a Metal Bar for Correction of Pectus Carinatum","volume":"30","year":"2014","journal-title":"Pediatr. Surg. Int."},{"issue":"06","key":"2023090510145817600_bib25","first-page":"519","article-title":"A Novel Method to Simulate Force-Chest Displacement Relationship During Cardiopulmonary Resuscitation","volume":"23","year":"2011","journal-title":"Biomed. Eng.: Appl., Basis Commun."},{"key":"2023090510145817600_bib26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4061\/2011\/702735","article-title":"The Bone-Muscle Relationship in Men and Women","volume":"2011","year":"2011","journal-title":"J. Osteoporosis"},{"issue":"2","key":"2023090510145817600_bib27","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.bone.2007.05.001","article-title":"Physical Activity and Femoral Neck Bone Strength During Childhood: The Iowa Bone Development Study","volume":"41","year":"2007","journal-title":"Bone"},{"issue":"2","key":"2023090510145817600_bib28","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1210\/jcem.86.2.7186","article-title":"The Development of Bone Strength at the Proximal Radius During Childhood and Adolescence","volume":"86","year":"2001","journal-title":"J. Clin. Endocrinol. Metab."},{"issue":"5","key":"2023090510145817600_bib29","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1177\/0363546505281916","article-title":"Maturation Leads to Gender Differences in Landing Force and Vertical Jump Performance: A Longitudinal Study","volume":"34","year":"2006","journal-title":"Am. J. Sports Med."},{"key":"2023090510145817600_bib30","first-page":"83","article-title":"Methods for Determining Pediatric Thoracic Force-Deflection Characteristics From Cardiopulmonary Resuscitation","volume":"52","year":"2008","journal-title":"Stapp Car Crash J."},{"key":"2023090510145817600_bib31","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.bone.2018.05.015","article-title":"Mechanical Properties of Infant Bone","volume":"113","year":"2018","journal-title":"Bone"}],"container-title":["Journal of Biomechanical Engineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/asmedigitalcollection.asme.org\/biomechanical\/article-pdf\/145\/11\/111009\/7038001\/bio_145_11_111009.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/asmedigitalcollection.asme.org\/biomechanical\/article-pdf\/145\/11\/111009\/7038001\/bio_145_11_111009.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T10:15:21Z","timestamp":1693908921000},"score":1,"resource":{"primary":{"URL":"https:\/\/asmedigitalcollection.asme.org\/biomechanical\/article\/145\/11\/111009\/1166294\/An-Aggregate-Sternal-Force-Deflection-Model"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,4]]},"references-count":31,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2023,11,1]]}},"URL":"https:\/\/doi.org\/10.1115\/1.4063148","relation":{},"ISSN":["0148-0731","1528-8951"],"issn-type":[{"type":"print","value":"0148-0731"},{"type":"electronic","value":"1528-8951"}],"subject":[],"published":{"date-parts":[[2023,9,4]]},"article-number":"111009"}}