Neurovascular risks of anteroinferior clavicular plating

Anteroinferior plating has been described for internal fixation of clavicular fractures, citing improved bicortical fixation, less hardware prominence, and safer drill trajectories compared with other plate configurations. This anatomic study defined structures at risk during anteroinferior clavicular plating. Four paired cadaveric specimens (8 clavicles) from ages 75 to 93 years were systematically dissected. Using the screw paths associated with an anteroinferior plate (anteroinferior to superoposterior), the distance from the posterior clavicle cortex to the nearest vital structure was measured at 5 different positions along the clavicle. In the medial half of the clavicle, the subclavian artery is in closest proximity to the clavicle, measuring, on average, 22.95 mm and 15.10 mm at point A and B. At the lateral three-fifths point of the clavicle (point C), the brachial plexus is 12.76 mm from the posterior clavicle and is more at risk than the subclavian artery. Lateral to the three-fifth point of the clavicle, there were no vital structures that could be injured by overdrilling. Our results suggest that more care should be observed with placement of screws in the medial half of the clavicle where subclavian artery damage is more likely.