![]() This pdf provides an update on the epidemiology, classification, diagnosis, and management of clavicle fractures, with a focus on the controversies and evidence regarding surgical treatment. An apical or lordotic view may then provide greater detail of the lung apices.Ĭhest x-rays are correctly aligned if the medial ends of clavicles are equidistant from the spinous process of vertebrae at the T4/5 level. Clavicle fractures are a frequent and challenging problem for orthopaedic surgeons. On a chest x-ray image, the clavicles are superimposed over the apex of both the lungs and obscure the subtle lesions. Distal clavicle fractures (DCF) are a management challenge frequently encountered by shoulder surgeons. Supraclavicular foramen: the clavicle may be pierced by a branch of supraclavicular nerveĪt the attachment of the costoclavicular (rhomboid) ligament, there may be a tuberosity or depression (rhomboid fossa) of variable size that may mimic disease a rhomboid fossa is more common in younger adults and males 4 The lateral end has intramembranous ossification. See main article: ossification centers of the pectoral girdle. It is also the last ossification center to fuse, around 22-25 years of age. Although distal clavicle fractures are relatively uncommon (2128 of total clavicle fractures 2), they bring some challenges and complications. It is the first bone to start ossification at around 5th-6th weeks of gestation. Nutrient branch from the suprascapular arteryĬlavicular branch of the thoracoacromial artery from the second part of the axillary artery Figure 2: A distal (lateral) clavicle fracture (red arrow) may be in the region (green star) of the ligaments that attached the clavicle to the scapula. acromioclavicular ligament, coracoclavicular ligament, sternoclavicular ligament, costoclavicular ligament, interclavicular ligament Distal clavicle fractures (Figure 2) may present with no deformity, and tenderness around the acromioclavicular (AC) joint, similar to an AC joint separation. Pectoralis major, sternocleidomastoid (clavicular head), deltoid, trapezius, subclavius, sternohyoid The clavicle articulates with the acromion at the acromioclavicular joint laterally and the sternum at the sternoclavicular joint medially. The female clavicle is shorter, thinner, less curved and smoother than the male clavicle. On the inferior surface of the medial clavicle is the costal tuberosity and subclavian groove, which form the attachment sites for costoclavicular ligament and subclavius muscle, respectively. On the inferior surface of the lateral third is the conoid tubercle for the attachment of the conoid ligament and lateral to this is the trapezoid line for attachment of the trapezoid ligament, both constituting the coracoclavicular ligament. The shaft connects the sternal (medial) end and the acromial (lateral) end. The clavicle is roughly "S-shaped" with a flattened, concave, lateral one-third and a thickened, convex, medial two-thirds.
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