The Anatomical Observation Of Plate-screw Fixation Of Clavicle Fracture

Objective To explore the anatomic features of adjacent structures underthe clavicle and the projection of these structures on the clavicle, and providemore detailed anatomic data for treating clavicle fractures with plate-screwfixation, guiding the direction and the safety length of the screw.Methods7adult cadaveric specimens without broken were selected,whose ages are unknown, to respectively observe subclavian vessels, brachialplexus, the clavicle and coracoid process. The projection area of the subclavianvessels, brachial plexus on the clavicle was measured and compared.Results The study found that it is the subclavian neurovascular bundlethat is easily injured in treating the clavicle fractures with plate-screw fixation.The neurovascular bundle goes from behind the clavicle toward below theclavicle. The neurovascular bundle is wrapped around by the subclavius, theanterior scalene muscle and the first rib when it goes under the clavicle. Thesubclavian vein, the subclavian artery and the brachial plexus appearsuccessively from the inner edge to the outer edge of the clavicle. Thesubclavian vein is always buried under the clavicle and it has no intersectionpoint with the trailing edge of the clavicle. The angles of the neurovascularbundle and the long axis of the clavicle is（45.9±1.4）°on average. The totallength of the clavicle is（13.405±0.347）cm on average. Projection area of theneurovascular bundle appear on the medial and middle1/4segment of the clavicle. The minimal distance from neurovascular bundle to the upper edge ofthe clavicle is（1.679±0.055）cm on average. By the level of coronoid process,the distance from neurovascular bundle to the upper edge of the clavicle is（5.686±0.215）cm on average.Conclusions When treating the clavicle fractures with plate-screwfixation, the medial and middle1/4segment of the clavicle is the danger area,the length of the screw which is screwed in that area must be strictly restrictedfor protecting adjacent neurovascular bundles, and the direction of the screwshould be pay attention for avoiding iatrogenic injury of the subclavianneurovascular bundle.