From the Guidelines
The important structures related to a clavicle fracture include the subclavian vessels, brachial plexus, lung apex, sternoclavicular and acromioclavicular joints, and multiple muscle attachments including the sternocleidomastoid, pectoralis major, deltoid, and trapezius, as well as the coracoclavicular ligaments. These anatomical elements can be affected during injury and may lead to complications beyond the bone injury itself, such as hemorrhage, vascular compromise, neurological symptoms, pneumothorax, and disruption of joint stability 1. The subclavian vessels (artery and vein) run beneath the clavicle and can be damaged in severe fractures, potentially causing hemorrhage or vascular compromise. The brachial plexus, a network of nerves supplying the upper limb, also passes beneath the clavicle and may be injured, resulting in neurological symptoms. The lung apex sits close to the clavicle, and displaced fracture fragments can cause pneumothorax in rare cases.
Key Structures
- Subclavian vessels (artery and vein)
- Brachial plexus
- Lung apex
- Sternoclavicular and acromioclavicular joints
- Multiple muscle attachments including the sternocleidomastoid, pectoralis major, deltoid, and trapezius
- Coracoclavicular ligaments
Understanding these anatomical relationships is essential for proper assessment and management of clavicle fractures, as damage to these structures can lead to complications beyond the bone injury itself, and surgical treatment of displaced midshaft clavicle fractures in adult patients is associated with higher union rates and better early patient-reported outcomes than nonsurgical treatment 1. However, practitioners may consider either surgical or nonsurgical treatment because both are associated with similar long-term patient-reported outcomes and patient satisfaction. The current evidence supports the importance of considering the individual patient's needs and circumstances when deciding on the optimal treatment approach 1.
From the Research
Important Structures Related to Clavicle Fracture
The important structures related to a clavicle fracture include:
- Subclavian artery: a major artery that supplies blood to the arm, located close to the clavicle [ 2, 3,4,5,6 ]
- Subclavian vein: a major vein that returns blood from the arm to the heart, also located close to the clavicle [ 2, 3,4,5,6 ]
- Brachial plexus: a network of nerves that controls muscle function and sensation in the arm, located near the clavicle [ 2, 3 ]
Location of Important Structures
The location of these important structures varies along the length of the clavicle:
- Medially (near the center of the body), the subclavian vein is closely associated with the clavicle, while the subclavian artery and brachial plexus are farther away 3
- At the junction of the middle and second-thirds of the clavicle, all three structures are within 2cm of the clavicle 3
- Laterally (near the shoulder), these structures move farther away from the clavicle, with the subclavian vein, artery, and brachial plexus at least 4.5cm away from the clavicle on average 3
Clinical Significance
Injuries to these important structures can occur as a result of clavicle fracture, particularly with high-energy trauma or comminuted fractures 2, 4, 5, 6. These injuries can be life-threatening and require urgent medical attention.