Anomalous external jugular vein: clinical concerns in treating clavicle fractures

Operative treatment of clavicle fractures has seen growing acceptance, as evidence emerges to support its use over nonoperative management. Of particular popularity, more recently, is the percutaneous intramedullary techniques for fixation of these injuries. The complex neurovascular anatomy in close proximity to the clavicle requires precision with these procedures. Anatomic variations in this region pose an even greater, and often unforeseen, danger to the operating surgeon and patient. Here, we present a case report of an anomalous external jugular vein coursing anterior to the clavicle that was encountered during an open surgical approach to a clavicle fracture. The purpose of this case presentation is to serve as a caution to surgeons treating clavicle fractures by both open and percutaneous means. Inadvertent injury to anomalous neurovascular structures can be devastating to the patient and can be avoided by the careful surgical approaches recommended.