The anatomic relationship of the axillary artery and vein to the clavicle: A cadaveric study

Abstract

Clavicle fractures are common, accounting for 5% to 12% of all fractures. 2 Basamania C.J. Craig E.V. Rockwood Jr., C.A. Fractures of the clavicle. in: Rockwood C.A. Matsen III, F.A. Wirth M.A. Lippitt S.B. The shoulder. 3rd ed. Saunders, Philadelphia2004: 455-519 Google Scholar , 31 Rowe C.R. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res. 1968; 58: 29-42 Crossref PubMed Google Scholar Eighty percent of fractures occur in the middle third. 25 Neer II, C.S. Nonunion of the clavicle. J Am Med Assoc. 1960; 172: 1006-1011 Crossref PubMed Scopus (446) Google Scholar Traditionally, the results of nonoperative management for these middle-third clavicle fractures have been thought to be good, with a rate of nonunion between 0.1% and 5%. 2 Basamania C.J. Craig E.V. Rockwood Jr., C.A. Fractures of the clavicle. in: Rockwood C.A. Matsen III, F.A. Wirth M.A. Lippitt S.B. The shoulder. 3rd ed. Saunders, Philadelphia2004: 455-519 Google Scholar , 25 Neer II, C.S. Nonunion of the clavicle. J Am Med Assoc. 1960; 172: 1006-1011 Crossref PubMed Scopus (446) Google Scholar , 28 Robinson C.M. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br. 1998; 80: 476-484 Crossref PubMed Scopus (644) Google Scholar However, there is increasing recognition of functional impairment after malunion of these fractures, especially where the clavicle is significantly shortened. 1 Altamimi S.A. McKee M.D. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. Surgical technique. J Bone Joint Surg Am. 2008; 90: 1-8 PubMed Google Scholar , 9 Chan K.Y. Jupiter J.B. Leffert R.D. Marti R. Clavicle malunion. J Shoulder Elbow Surg. 1999; 8: 287-290 Abstract Full Text PDF PubMed Scopus (91) Google Scholar , 21 Ledger M. Leeks N. Ackland T. Wang A. Short malunions of the clavicle: an anatomic and functional study. J Shoulder Elbow Surg. 2005; 14: 349-354 Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar , 24 McKee M.D. Wild L.M. Schemitsch E.H. Midshaft malunions of the clavicle. J Bone Joint Surg Am. 2003; 85: 790-797 Crossref PubMed Scopus (235) Google Scholar As a result of this and the identification of groups of patients with a high risk of nonunion, 7 Brinker M.R. Edwards T.B. O'Connor D.P. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2005; 87: 676-677 PubMed Google Scholar , 12 Gossard J.M. Closed treatment of displaced middle-third fractures of the clavicle gives poor results [letter]. J Bone Joint Surg Br. 1998; 80: 558 PubMed Google Scholar , 14 Hill J.M. McGuire M.H. Crosby L.A. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br. 1997; 79: 537-539 Crossref PubMed Scopus (560) Google Scholar , 29 Robinson C.M. Court-Brown C.M. McQueen M.M. Wakefield A.E. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2004; 86: 1359-1365 PubMed Google Scholar , 35 Wick M. Muller E.J. Kollig E. Muhr G. Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion. Arch Orthop Trauma Surg. 2001; 121: 207-211 Crossref PubMed Scopus (109) Google Scholar there has been increased interest in internal fixation of selected clavicle fractures. The availability of site-specific locking plates and intramedullary fixation devices has facilitated this change in practice. Neurovascular complications have been reported from both plate osteosynthesis 8 Casselman F. Vanslembroek K. Verougstraete L. An unusual cause of thoracic outlet syndrome. J Trauma. 1997; 43: 142-143 Crossref PubMed Scopus (29) Google Scholar , 16 Johnson B. Thursby P. Subclavian artery injury caused by a screw in a clavicular compression plate. Cardiovasc Surg. 1996; 4: 414-415 Crossref PubMed Scopus (33) Google Scholar , 32 Shackford S.R. Connolly J.F. Taming of the screw: a case report and literature review of limb-threatening complications after plate osteosynthesis of a clavicular nonunion. J Trauma. 2003; 55: 840-843 Crossref PubMed Scopus (45) Google Scholar and intramedullary fixation of midshaft clavicle fractures. 27 Ring D. Holovacs T. Brachial plexus palsy after intramedullary fixation of a clavicular fracture. A report of three cases. J Bone Joint Surg Am. 2005; 87: 1834-1837 Crossref PubMed Scopus (46) Google Scholar