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 reviewexamines anatomical variations in rib-sternum attachments and their clinical significance through analysis of literature from1993–2023. Variations, including bifid ribs (0.15%–3.4% prevalence) and cervical ribs (0.05%–3.0%), can lead to conditionslike slipping rib syndrome (SRS). An extensive search of PubMed, Embase, Google Scholar, Web of Science, and specializedcollections identified 17 comprehensive SRS case reports. Two independent reviewers evaluated these cases, revealing thatrib-sternum morphological variations significantly impact respiratory biomechanics, with unstable costal cartilage identifiedas a primary cause of pain syndromes. These findings highlight the critical importance of recognizing aberrant rib-sternumanatomy for patient safety, particularly in thoracic procedures. Advanced imaging technologies have enhanced detectioncapabilities, allowing for improved surgical planning and patient management. This review underscores the value of bothcadaveric and radiological examination in identifying these variations, and recommends further research to clarify theirprevalence, functional implications, and clinical correlations to optimize treatment approaches and outcomes.