CLAVICLE
CLAVICLE
- The clavicle or collar bone is one of the bones of shoulder girdle.
- It is long slender bone that lies horizontally across the root of neck just beneath the skin.
Peculiar features of Clavicle:
- First bone to begin ossification (during 5th to 6th week of fetal development)
- Last bone to complete ossification (at age 21)
- Only long bone with 2 ossification center.
- Only long bone to be ossified intramembranously.
- Most commonly fracture long bone in body.
- Most common bone that fractures during birth.
- Common injury in babies are clavicle #.
- It has no medullary cavity.
- The most common site of fracture of clavicle is the junction of the middle third and outer third (i.e. junction of medial 2/3rd and lateral 1/3rd).
- Only horizontally lying long bone of body.
MUSCLE ATTACHMENTS OF CLAVICLE:
- Muscles inserting into clavicle: Trapezius, Subclavius.
- Muscles originating from clavicle: Pectoralis Major, Deltoid, Sternohyoid, Sternocleidomastoid
LIGAMENT ATTACHMENT OF CLAVICLE:
- Interclavicular ligament (superiorly at medial end)
- Costoclavicular ligament (inferior surface of middle of shaft)
- Trapezoid ligament & conoid ligament (at trapezoidal line on lateral 3rd of shaft)
- A part of coracoclavicular ligament (at lateral end of clavicle which connects it with acromion of scapula to form acromioclavicular joint).
BLOOD SUPPLY OF CLAVICLE
- Suprascapular, Thoracoacromial, Internal Thoaracic
NERVE SUPPLY OF CLAVICLE
- Branchial Plexus
CLINICAL SIGNIFICANCE
1. Clavicle fracture
- Injury by fall with arm out or fall onto shoulder, or direct blow on shoulder.
- Most common in middle 1/3rd of bone.
- Signs are pain, swelling, tenderness, subcutaneous lump.
- Diagnosis: by A-P view of x-ray of chest, Zanca view, CT Scan
- Managment:-undisplaced- triangular sling with active exercise of finger wrist & elbow displaced-
- fig.8 bandage(best for treatment of #clavicle in children) ( in case of open #, neurovascular injuries, associated # go for open reduction operative procedure)
Complication:
- early:# fragment may injure subclavian vessels or branchial plexus
- late :malunion, shoulder stiffness(prevented by shoulder moblization)
2. Acromioclavicular dislocation
- Occurs when impact occurs on superior part of acromion. pain at AC joint, cross arm adduction
- Degree of dislocationDiagnosis is done by x-ray
- 1st degree (stretching of ligament but joint is maintained)
- 2nd degree (tearing of joint capsule & coracoclavicular ligament)
- 3rd degree (total disruption of joint and ligament)
- Managment: traction-countertraction method, hippocrates method, stimpson’s technique, kocher’s technique
- (Velpeau bandage & sling and swathe splint are used)
3. Degeneration of clavicle
4. Osteolysis
5. Sternoclavicular dislocation
6. Missing clavicle:( seen in cleidocranial dysostosis)
Exam Question
Clavicle
- First bone to ossify.
- Complete ossification at 21yr.
- Only long bone to ossify intramembranously.
- Most common bone to fracture during birth .
- Common injury in babies are clavicle #.
- Coracoclavicular ligament (at lateral end of clavicle which connects it with acromion of scapula to form acromioclavicular joint).
- No medullary cavity.
- Clavicle fracture: Most common in middle 1/3rd of bone.
- The most common complication of clavicle fracture is Malunion.
- Treatment of fracture clavicle in an infant is best treated by Figure of 8 bandage.
- Missing clavicle seen in cleidocranial dysostosis.
- Shoulder stiffness can be managed by shoulder movement after patient is pain free.
Don’t Forget to Solve all the previous Year Question asked on CLAVICLE