BLOOD SUPPLY AND INNERVATION OF CLAVICLE BONE
Keywords:
clavicle, anatomy, blood supply, innervationAbstract
The clavicle bone is interesting with its horizontal position and with S shaped form. Another fact that makes the clavicle bone to stands out of other bones of axial skeleton is its periosteal ossification. The knowledge of these bone blood supply is really important, because the most frequent choice of implant fixation is open reduction and internal fixation. The surgical procedure is made with plate and screws. If the surgeon makes the perfect reposition and fixation from Biomechanical point of view, but harms the periosteum and blood supply of the bone this will cause a fracture non healing. This research is focused above blood supply and innervation around the clavicle bone. If the operation technique is successful and there is bone healing, which is proved by bone healing seen on X-Rays and there is injury of the supraclavicular nerves, the patient will not be satisfied from the procedure. This investigation focuses on the vessel and nerve supply of the bone to help the practitioner of better understanding, so they can improve their results in the clinical filed. For this research the articles from PubMed are used, and the Anatomy books. All the articles were specially oriented in vessel and nerve anatomy around the clavicle.The results are systemized in two parts: first is oriented on the vessels and nerves around the clavicle bone and the second part is especially for the blood and nerve supply of the bone. Arteria subclavia, Vena subclavia, Plexus brachialis, the blood supply to the clavicle bone, nervi supraclaviculares, the lateral pectoral nerve and subclavian nerve are examined. With clinical value is the position of the supraclavicular nerves, because they are on the way of the surgical approach and easily can be damaged.It is important knowing the surgical anatomy of the clavicle and surrounding structures to provide the successful surgical approached and good outcomes of the surgical procedure and to fulfil the patient’s requirements. The distance between the neuro-vascular bundle and the clavicle bone and also the angle they are positioned against each other is from great importance for avoid iatrogenic injury of the neuro-vascular structures during surgical procedures. The surgeon must pay attention not only with the orientation of the drill bit, but also of the penetration of the second cortex of the bone. Another anatomical details that must be taken in mind is the position of nutrition foramen so not disturbed the biology of the bone during osteosynthesis. In the literature the different authors report the different position of the nutritive foramen of clavicle bone. A cadaveric study on embalmed human clavicles concludes that in 94.64% of cases the dominant foramen is located in the middle third. Other based on computed tomography images shows that the nutrient foramen is mostly located closer to the sternal end of the bone. There is need from more evidence-based investigation in this area to clarified the correct information.
References
FW Knudsen, Andersen, M., & Krag, C. (1989). The arterial supply of the clavicle, 211–214.
Havet, E., Duparc, F., Muller, A. T. J., Delas, B., & Fréger, P. (2008). Vascular anatomical basis of clavicular non-union, 23–28. https://doi.org/10.1007/s00276-007-0278-1
Hu, R., Su, Y.-J., & Chien, C.-S. (2023). Supraclavicular nerve sparing versus sacrifice during open reduction internal fixation of acute midshaft clavicle fracture. Journal of Orthopaedic Surgery and Research, 18(1), 725. https://doi.org/10.1186/s13018-023-04220-7
Huang, D., Deng, Y., Cheng, J., Bong, Y. R., Schwass, M., & Policinski, I. (2021). Comparison of patient reported outcomes following clavicle operative fixation using supraclavicular nerve sparing and supraclavicular nerve sacrificing techniques- A cohort study. Injury, 52(3), 501–505. https://doi.org/10.1016/j.injury.2020.10.100
Leschinger, T., Krane, F., Hackl, M., Tongel, A. Van, Scaal, M., Peter, L., & Wegmann, K. (2018). The dominant nutrient foramen at the clavicular midshaft : an anatomical study. Surgical and Radiologic Anatomy, 0(0), 0. https://doi.org/10.1007/s00276-018-2169-z
Leurcharusmee, P., Maikong, N., Kantakam, P., Navic, P., Mahakkanukrauh, P., & Tran, D. (2021). Innervation of the clavicle: a cadaveric investigation. Regional Anesthesia and Pain Medicine, 46(12), 1076–1079. https://doi.org/10.1136/rapm-2021-103197
Lorsuwannarat, N., & Jirangkul, P. (2023). Safe zone of supraclavicular nerve during clavicle fixation and its anatomical variations, a cadaveric study. Archives of Orthopaedic and Trauma Surgery, 143(9), 5677–5685. https://doi.org/10.1007/s00402-023-04874-2
Nathe, T., Tseng, S., & Yoo, B. (2011). The anatomy of the supraclavicular nerve during surgical approach to the clavicular shaft. Clinical Orthopaedics and Related Research, 469(3), 890–894. https://doi.org/10.1007/s11999-010-1608-x
Natsis, K., Totlis, T., Chorti, A., & Karanassos, M. (2015). Tunnels and grooves for supraclavicular nerves within the clavicle : review of the literature and clinical impact. Surgical and Radiologic Anatomy. https://doi.org/10.1007/s00276-015-1602-9
Sinha, A., Edwin, J., Sreeharsha, B., Bhalaik, V., & Brownson, P. (2011). UPPER LIMB A radiological study to define safe zones for drilling during plating of clavicle fractures, 93(8), 1247–1252. https://doi.org/10.1302/0301-620X.93B9.25739
Vatansever, A., & Demiryürek, D. (2020). Morphometric analyses of clavicle ’ s nutrient foramen. Surgical and Radiologic Anatomy, (0123456789). https://doi.org/10.1007/s00276-020-02433-7