Clavicle

INTRODUCTION
  • 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
  • Only horizontally lying long bone of body
MUSCLE ATTACHMENTS OF CLAVILE
  • 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
  • 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 
  1. early:# fragment may injure subclavian vessels or branchial plexus
  2. late :malunion, shoulder stiffness(prevented by shoulder moblization)
Acromioclavicular dislocation
  • Occurs when impact occurs on superior part of acromion. pain at AC joint, cross arm adduction
  • Degree of dislocation
  1. 1st degree(stretching of ligament but joint is maintained) 
  2. 2nd degree(tearing of joint capsule & coracoclavicular ligament) 
  3. 3rd degree(total disruption of joint and ligament)
  • Diagnosis is done by x-ray
  • Managment: traction-countertraction method, hippocrates method, stimpson's technique, kocher's technique
  • (Velpeau bandage & sling and swathe splint are used)
Degeneration of clavicle
Osteolysis
Sternoclavicular dislocation
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, 
  • M/C Complication of # Clavicle is malunion
  • Management involves fig.8 bandage(best for treatment of #clavicle in children)
  • Acromioclavicular dislocation :Velpeau bandage & sling and swathe splint
  • 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