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| Clavicle | |
|---|---|
| Name | Clavicle |
| Latin | Clavicula |
| System | Skeletal system |
| Partof | Pectoral girdle |
Clavicle The clavicle is a long bone that serves as a strut between the scapula and the sternum, forming part of the pectoral girdle and contributing to shoulder mobility and thoracic protection. It articulates medially with the sternum at the manubrium and laterally with the acromion of the scapula, transmitting forces from the upper limb to the axial skeleton and providing attachment sites for muscles such as the sternocleidomastoid, trapezius, pectoralis major, and deltoid. The bone's S-shaped curvature and subcutaneous position make it prone to fractures and palpable landmarks used by clinicians in settings from the Royal College of Surgeons training to emergency care in institutions like Mayo Clinic and Johns Hopkins Hospital.
The clavicle is divided into a medial (sternal) end, a shaft, and a lateral (acromial) end; it lies horizontally above the first rib and deep to the platysma and superficial veins visible in examinations at Guy's Hospital or Addenbrooke's Hospital. Medially, the sternal end articulates with the sternoclavicular joint, reinforced by the costoclavicular ligament and the sternoclavicular ligaments described in classical atlases from Gray's Anatomy; laterally, the acromial end forms the acromioclavicular joint with the acromion and receives stabilization from the coracoclavicular ligament (conoid and trapezoid portions), terms standardized by the International Society of Orthopaedic Surgery and Traumatology (SICOT). The subclavian groove on the inferior surface marks the attachment of subclavius; muscular attachments include the sternocleidomastoid medially, pectoralis major anteriorly, deltoid laterally, and trapezius posteriorly, with vascular relations to the subclavian artery and subclavian vein that are relevant in procedures at centers like Cleveland Clinic.
Embryologically, ossification begins in the fetal period with medial and lateral ossification centers; this pattern is documented in classical embryology texts used at institutions such as University of Cambridge and Harvard Medical School. The clavicle is one of the first long bones to ossify, with intramembranous and endochondral components noted in comparative studies from museums like the Natural History Museum, London and research published by scholars affiliated with University of Oxford and Stanford University. Growth plate fusion occurs later in adolescence, a detail important to pediatric orthopedic services at Great Ormond Street Hospital and Boston Children's Hospital.
Mechanically, the clavicle acts as a strut to maintain the lateral position of the shoulder, optimizing leverage for muscles described in monographs from Royal Society of Medicine collections and biomechanical analyses from Massachusetts Institute of Technology laboratories. It protects neurovascular structures including the brachial plexus and subclavian vessels, a relationship emphasized in surgical teachings at Guy's Hospital and St Thomas' Hospital. The clavicle contributes to respiration by stabilizing the thoracic inlet, a physiological role explored in studies at Karolinska Institutet and Imperial College London.
Palpable landmarks of the clavicle guide central venous access and procedures like subclavian catheterization taught in curricula at Mayo Clinic and Johns Hopkins Hospital; its subcutaneous location makes superficial infections, osteomyelitis, and tumors detectable in oncology centers such as MD Anderson Cancer Center and Royal Marsden Hospital. Orthopedic classifications (e.g., Neer classification) and prognostic systems developed at institutions like University of California, San Francisco inform management protocols in trauma centers including Mount Sinai Hospital and Toronto General Hospital. The clavicle's role in congenital syndromes has been described in genetic clinics at Great Ormond Street Hospital and Oxford University Hospitals.
Clavicular fractures commonly occur at the middle third and are frequent in contact sports and accidents investigated by teams from FIFA medical programs, International Olympic Committee studies, and trauma registries at National Health Service hospitals. Management ranges from conservative sling immobilization promoted in guidelines from National Institute for Health and Care Excellence (NICE) and American Academy of Orthopaedic Surgeons to operative fixation using plates or intramedullary devices developed by manufacturers collaborating with centers like Cleveland Clinic and Hospital for Special Surgery. Complications include nonunion, malunion, neurovascular injury to the brachial plexus, and posttraumatic acromioclavicular joint dysfunction studied at University of Pennsylvania and Duke University Medical Center.
Anatomic variants include complete or partial clavicular duplication, bifid clavicle, and congenital hypoplasia associated with syndromes such as Cleidocranial dysostosis (linked to mutations studied at University College London and National Institutes of Health), with bilateral absence reported in historical case series from Johns Hopkins Hospital. Developmental anomalies may co-occur with craniofacial findings documented in texts from Guy's Hospital and genetic reports from Royal Children's Hospital.
Radiographs (AP, cephalic tilt), computed tomography protocols, and MRI sequences for clavicular evaluation are standardized in radiology departments at Mayo Clinic and Karolinska Institutet; CT 3D reconstructions aid preoperative planning in centers like Charité – Universitätsmedizin Berlin and Scripps Clinic. Surgical approaches include open reduction and internal fixation with precontoured locking plates described in technique guides from AO Foundation and minimally invasive intramedullary fixation pioneered in trials at University of British Columbia and Seoul National University Hospital. Neurovascular landmarks for safe dissection are emphasized in operative atlases authored by surgeons from Royal College of Surgeons and American College of Surgeons.
Category:Bones of the upper limb