The Anatomy of the Clavicle and Its In Vivo Relationship to the Vascular Structures: A 2D and 3D Reconstructive Study...

To describe in detail both the proximity and location of the subclavian vessels relative to both the right and left clavicle. This will give surgeons a more precise knowledge of safe and dangerous areas for screw placement during operative stabilization of clavicle fractures.

A radiology storage database was reviewed to obtain a total sample of 103 clavicles with no evidence of periclavicular pathology. Each clavicle was divided along its length into 13 specific points of measurement. At each point, the distance and angular position between the clavicle and each subclavian vessel were measured.

The mean distance of the subclavian artery was greater than 10 mm at all positions. At the most medial point of the clavicle, the right subclavian artery was on average 1 cm closer to the clavicle than on the left. From medial to lateral, in the sagittal plane, the position of the subclavian artery transitions obliquely across the clavicle from a 2 to 6 o'clock position. The mean distance to the subclavian vein is less than 10 mm along the medial half of the clavicle on both sides of the body. In these areas, the position of the subclavian vein to the clavicle transitions from the 3 to 5 o'clock positions from medial to the mid-point of the clavicle.

The subclavian vein is the vascular structure at highest risk during clavicle fracture fixation. The major area of danger in our study is the medial clavicle with distance being less than 1 centimeter over the entire medial half of the clavicle on both right and left. In this danger area, the subclavian vein courses from 3 to 5 o'clock positions. The subclavian artery is more distant and relatively safer but is closer at the right medial clavicle than the left.