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Case 1 Clavicle Fracture (Broken Collarbone) - NUI Galway

Case 1 clavicle fracture ( broken collarbone ) Anatomical Region and Surface Anatomy of the Clavicle . The Clavicle is located in the pectoral girdle. It is located also in the anterior and superior portion of the thorax, placed almost horizontally above the first rib. Medially the Clavicle articulates with the manubrium of the sternum, at what is known as the sternoclavicular joint. Laterally the Clavicle articulates with the acromion of the scapula at the acromioclavicular joint. Because the Clavicle is the only skeletal connection of the pectoral girdle to the trunk of the body, it serves as a strut which maintains the upper limb at a suitable distance from the thorax, so as to allow for maximum movement of the arm.

Case 1 Clavicle Fracture (Broken Collarbone) Anatomical Region and Surface Anatomy of the Clavicle. The clavicle is located in the pectoral girdle.

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Transcription of Case 1 Clavicle Fracture (Broken Collarbone) - NUI Galway

1 Case 1 clavicle fracture ( broken collarbone ) Anatomical Region and Surface Anatomy of the Clavicle . The Clavicle is located in the pectoral girdle. It is located also in the anterior and superior portion of the thorax, placed almost horizontally above the first rib. Medially the Clavicle articulates with the manubrium of the sternum, at what is known as the sternoclavicular joint. Laterally the Clavicle articulates with the acromion of the scapula at the acromioclavicular joint. Because the Clavicle is the only skeletal connection of the pectoral girdle to the trunk of the body, it serves as a strut which maintains the upper limb at a suitable distance from the thorax, so as to allow for maximum movement of the arm.

2 The Clavicle also serves to protect underlying neurovascular bundles the subclavian vessels, the transverse scapular vessels and the brachial plexus of nerves. The Clavicle presents a double curvature medially it presents an anterior convexity, while laterally it presents an anterior concavity. The lateral end of the bone is somewhat flattened, the medial end is more rounded or prismatic. Superior Surface of left Clavicle The lateral third is seen to have two borders and two surfaces. The anterior border is concave, while the thicker posterior border is convex. Both are marked with impressions for the attachment of the deltoid muscle on the anterior border and the trapezius muscle on the posterior border.

3 The superior surface is flat, and between the points of attachment of deltoid and trapezius lies an area of subcutaneous bone. On the posterior boder of the inferior surface lies a rough eminence known as the corocoid tuberosity (conoid tubercle) which is the point of attachment of the conoid ligament. Running anterolaterally from this is the oblique or trapezoid ridge, which is the point of attachment of the trapezoid ligament. Together these ligaments make up the coracoclavicular ligament. The medial two-thirds of the Clavicle has three borders and three surfaces. The anterior border, continuous with the anterior margin of the lateral third, is the point of attachment of the pectoralis major.

4 The superior border, continuous with the posterior border of the lateral third, is the point of attachment of the sternocleidomastoid muscle. The posterior or subclavian border runs from the coracoid tuberosity to the costal tuberosity. This represents the posterior boundary of the groove for subclavius muscle. The anterior surface lies between the anterior and superior borders. The posterior,or cervical border lies between the posterior, or subclavian border and the superior border and faces toward the root of the neck. This surface is in contact with the transverse scapular vessels, the subclavian vessels and the brachial plexus of nerves. It also contains the oblique foramen, which is the point of entry of the chief nutrient artery to the bone.

5 The inferior or subclavian surface lies between the anterior and subclavian borders. Features include the costal tuberosity (rhomboid impression) for attachment of the costoclavicular ligament, and the subclavian groove, which is the point of attachment of the subclavius muscle. Inferior Surface of left Clavicle The sternal extremity of the Clavicle is triangular in form, and faces anteriorly, inferiorly and medially. It articulates with the manubrium of the sternum at the sternoclavicular joint. It presents an articular facet, which through the intervention of an articular disc allows this articulation. The lower part of the articular facet extends on to the inferior surface and articulates with the cartilage of the first rib.

6 The circumference of the articular surface is rough, as it is here that the ligaments supporting the sternoclavicular joint attach. These include the costoclavicular and sternoclavicular ligaments. The acromial (lateral) extremity is smaller and somewhat oval-shaped. It is directed obliquely and inferiorly, and articulates with the acromion of scapula. The circumference of the articular surface of this extremity is also rough, again due to it being the point of attachment of ligament (coracoclavicular ligament). Because the Clavicle is so well anchored at both extremities, it is unlikely to Fracture in the medial or lateral thirds. In 80% of cases the Fracture will take place in the middle third of the shaft.

7 It is common for the fragments of bone to be displaced following a Fracture . This is due to the action of the muscles attached to the bone. The sternocleidomastoid causes the medial fragment to be displaced upwards. The trapezius is unable to hold up the lateral fragment, which is consequently displaced by the pull of the deltoid muscle and the weight of the arm. Definition: A Clavicle Fracture is a break in the Clavicle bone (also called the collarbone ). It connects the sternum (breastplate) to the shoulder. The Clavicle can Fracture in three different places: Middle Third the middle portion of the Clavicle , which is the most common site for a Clavicle Fracture .

8 Distal Third the end of the Clavicle connecting to the shoulder Medial Third the end of the Clavicle connecting to the sternum On each side, the Clavicle extends horizontally from the manubrium of the sternum medially to the acromion of the scapula laterally. It is typical 13-15 cm in length. The medial two-thirds is convex anteriorly and roughly quadrilateral in cross-section. The lateral one third is concave anteriorly and flatter. The anterosuperior surface of the bone is smoother than the inferior surface and lies subcutaneously. It is crossed by the supraclavicular nerves and occasionally a communication between the external jugular and cephalic veins.

9 Understanding the Anatomy Physicians need to understand the anatomy of the injured region and the mechanics of the injury to make the proper diagnosis and suggest appropriate treatment. The Clavicle is an S-shaped bone that connects the shoulder girdle to the trunk. It is a rigid strut that maintains the shoulder in a functional position in relationship to the axial skeleton and allows varied hand positions in sports. The deltoid, pectoralis major, trapezius, sternocleidomastoid, and subclavius all insert or originate on the Clavicle and can cause deforming forces after an injury. In addition to its structural function, the Clavicle protects major underlying neurovascular structures as they pass from the neck to the axilla.

10 This fact is especially important because Clavicle fractures--especially of the medial aspect--can compromise the costoclavicular space and injure neurovascular structures (2,3). Fortunately, Clavicle injuries with associated significant neurovascular injuries are quite rare. The Clavicle articulates with the acromion to form the acromioclavicular (AC) joint and with the sternum to form the sternoclavicular (SC) joint (figure 1: not shown). The AC joint is a diarthrodial joint between the lateral end of the Clavicle and the medial margin of the acromion. Several ligaments reinforce the joint capsule to maintain stability. The AC ligament and the capsule provide anterior-posterior and medial-lateral stability, while the coracoclavicular ligaments provide vertical stability.


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