title: Anatomic relationships after instrumentation of the midshaft clavicle with 3.5-mm reconstruction plating: an anatomic study.
abstract: OBJECTIVE
  To examine the anatomic relationships of the major neurovascular structures at the midshaft clavicle region as they pertain to plate osteosynthesis in the treatment of midshaft clavicle fractures.
  
  
  METHODS
  Fifteen fresh cadaveric specimens were dissected at the clavicle region. The shortest distances from the midshaft clavicular fracture lines to the subclavian artery and vein and brachial plexus were measured with a digital caliper with the limb in anatomic position and at 90° of abduction. The mean and range distance values were recorded. The clavicles were then instrumented with eight-hole, 3.5-mm reconstruction plates and screws (Synthes, Paoli PA) placed in superior and anteroinferior positions. The shortest distances from the screw tips to the neurovascular structures were measured at variable plate positions, fracture zones, and limb positions. The incidence of screw tip contact was reported.
  
  
  RESULTS
  In 20% (three of 15) of the specimens, screw tip contact with a major neurovascular structure occurred. In these three specimens, two screw tip contacts occurred with the plate in a superior position and two occurred with the plate in an anteroinferior position. In one specimen, screw tip contact occurred with both plate positions. Limb abduction to 90° consistently increased the distance of the neurovascular structures from the clavicle. There was no observable trend in screw contact frequency in respect to limb position or fracture zone.
  
  
  CONCLUSIONS
  Caution must be exercised when instrumenting midshaft clavicle fractures regardless of chosen plate position. Limb abduction to 90° provides an added measure of safety during clavicle instrumentation.
authors: Orthopedic Surgery, Ohio University, Mercy St Vincent Medical Center, Toledo, OH 43608, USA.
authors: Steven Douglas
authors: SD
authors: Werner
authors: Jason
authors: J
authors: Reed
authors: Tobin
authors: T
authors: Hanson
authors: Todd
authors: T
authors: Jaeblon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D001863:Bone Screws; D001917:Brachial Plexus / Q000033:anatomy & histology; D002102:Cadaver; D002968:Clavicle / Q000033:anatomy & histology* / Q000293:injuries; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D050723:Fractures, Bone / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011187:Posture; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods; D013348:Subclavian Artery / Q000033:anatomy & histology; D013350:Subclavian Vein / Q000033:anatomy & histology