Redefining the morphometry of subclavian vessels for clavicle fracture treatments

• Published in: Surgical and radiologic anatomy (English ed.) Vol. 41; no. 4; pp. 365 - 372
• Main Authors: Vatansever, Alper, Demiryürek, Deniz, Erçakmak, Burcu, Özsoy, Hakan, Hazirolan, Tuncay, Şentürk, Yunus Emre
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.04.2019; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Anatomic Landmarks; Anatomy; Catheters; Children; Clavicle; Clavicle - blood supply; Clavicle - diagnostic imaging; Clavicle - injuries; Computed tomography; Computed Tomography Angiography; Contrast Media; Female; Fractures; Fractures, Bone - diagnostic imaging; Fractures, Bone - therapy; Humans; Imaging; Imaging, Three-Dimensional; Injuries; Male; Medicine; Medicine & Public Health; Middle Aged; Morphometry; Original Article; Orthopedics; Osteosynthesis; Pseudoaneurysm; Radiographic Image Interpretation, Computer-Assisted; Radiology; Retrospective Studies; Sex Factors; Sternoclavicular Joint - blood supply; Sternoclavicular Joint - diagnostic imaging; Sternoclavicular Joint - injuries; Subclavian Artery - anatomy & histology; Subclavian Artery - diagnostic imaging; Subclavian Artery - injuries; Subclavian Vein - anatomy & histology; Subclavian Vein - diagnostic imaging; Subclavian Vein - injuries; Surgery; Veins & arteries; 3D reconstruction; Clavicle; Computed tomography; Subclavian vessels
• ISSN: 0930-1038; 1279-8517
• DOI: 10.1007/s00276-018-2132-z

Purpose Clavicle fractures are common injuries in adults and children. Although neurovascular damage is rarely seen, acute subclavian artery pseudoaneurysms and injuries to subclavian vessels were reported for closed fractures of the clavicle. The aim of this study was to identify the morphological details of the subclavian vessels and their relation to the sternoclavicular joint and body of the clavicle. Methods 127 patients (66 females and 61 males) were evaluated using reconstructed three-dimensional computed tomographic angiographies. The point at which the subclavian artery crossed posterior to the clavicle was detected as a landmark. The medio-lateral distance between the sternal end of the clavicle, landmark, antero-posterior distance between the clavicle and the subclavian artery, diameter of the artery and vein, angle between the subclavian artery and vein, distance of the subclavian vein to the subclavian artery and the clavicle at the landmark were measured. Measurements were compared according to gender and right and left sides, and age correlation was determined. Results Morphometric relationship between the subclavian vessels and clavicle presented differences between genders. We measured the antero-posterior distance between the subclavian artery and the clavicle to be less than 1 cm (0.91 cm). Conclusion The subclavian artery travelled longer distances in men than women to reach the point that it crossed the clavicle. Our results demonstrated that the subclavian artery does not pass from the inferior margin of the clavicle, thus, superior plate osteosynthesis does not have any risk to injury against the subclavian vessels during the management of the clavicle fractures.