Clavicular caution: an anatomic study of neurovascular structures

Area of Science:

• Orthopedic Surgery
• Anatomy
• Biomechanics

Background:

• Open reduction and internal fixation (ORIF) is a common treatment for midshaft clavicle fractures.
• Potential complications include injury to critical neurovascular structures like the subclavian artery and vein.
• Current surgical approaches often lack direct visualization or palpation of these deep structures.

Purpose of the Study:

• To precisely map the anatomical relationship between the clavicle and adjacent major neurovascular structures.
• To identify critical zones during clavicle fracture surgery where neurovascular injury risk is highest.

Main Methods:

• Utilized five fresh frozen cadaveric specimens.
• Performed sagittal sectioning at 15mm intervals using a band saw.
• Measured distances from the clavicular cortex to the subclavian artery, subclavian vein, and brachial plexus.

Main Results:

• The subclavian vein demonstrated close proximity (4.8mm) to the medial clavicle.
• The subclavian artery and brachial plexus were over 2cm from the medial clavicle.
• All three neurovascular structures were within 2cm of the clavicle at the junction of the middle and second-thirds, moving further away laterally.

Conclusions:

• The medial third of the clavicle is in close proximity to significant neurovascular structures.
• Surgical interventions in this region require extreme caution, particularly when using drills, depth gauges, and clamps.
• Enhanced anatomical awareness can mitigate risks during clavicle ORIF procedures.