Aberrant rib cage anatomy with false ribs attachment to the sternum: review of the literature focused on slipping ribs syndrome case reports

The thoracic cage, formed by ribs and sternum, protects vital organs while enabling respiration. This review examines anatomical variations in rib-sternum attachments and their clinical significance through analysis of literature from 1993-2023. Variations, including bifid ribs (0.15%-3.4% prevalence) and cervical ribs (0.05%-3.0%), can lead to conditions like slipping rib syndrome (SRS). An extensive search of PubMed, Embase, Google Scholar, Web of Science, and specialized collections identified 17 comprehensive SRS case reports. Two independent reviewers evaluated these cases, revealing that rib-sternum morphological variations significantly impact respiratory biomechanics, with unstable costal cartilage identified as a primary cause of pain syndromes. These findings highlight the critical importance of recognizing aberrant rib-sternum anatomy for patient safety, particularly in thoracic procedures. Advanced imaging technologies have enhanced detection capabilities, allowing for improved surgical planning and patient management. This review underscores the value of both cadaveric and radiological examination in identifying these variations, and recommends further research to clarify their prevalence, functional implications, and clinical correlations to optimize treatment approaches and outcomes.