title: Proximity of Vital Structures to the Clavicle: Comparison of Fractured and Non-fractured Side.
abstract: BACKGROUND
  Previous anatomic and radiological studies have described the relationship of the clavicle to major neurovascular structures in healthy subjects. We were curious about this relationship in patients with a clavicle fracture and if it is different from non-fractured clavicles.
  
  
  METHODS
  We retrospectively identified all patients with a clavicle fracture between July 2001 and October 2013 in two level 1 trauma centers. Patients aged 18 years or greater with an acute unilateral clavicle fracture and a chest CT scan in the supine position displaying both clavicles and the complete fracture were included. Seventy patients were available for study. The distance was measured from the fracture site and from the closest clavicular cortex to the closest major artery, major vein, and inner surface of the thoracic cavity. CT data was evaluated in OsiriX DICOM viewer software with the use of three-dimensional Multiplanar Reconstruction.
  
  
  RESULTS
  Compared to the fractured side, the clavicle was significantly closer to the artery and vein on the non-fractured side (P<0.001 andp=0.0025 respectively). There was a significant difference in the median distance of the fracture site to the artery, vein, and inner surface of thoracic cavity between the different types of fractures (P<0.001). A post-hoc comparison showed significant differences in all distances between fracture types, except for the distance of proximal third compared to middle third fractures to the closest artery (P=0.41). There was no significant difference in distance when the arm is up overhead compared to down by the side of the body in computed tomography (CT) scans.
  
  
  CONCLUSIONS
  A fracture of the clavicle changes the relationship of the clavicle to major vital structures. The minimum distance of the clavicle to the closest artery and vein is significantly less on the non-fractured side, compared to the fractured side.
authors.affiliation: Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Frans J
authors.initials: FJ
authors.lastname: Mulder
authors.affiliation: Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jos J
authors.initials: JJ
authors.lastname: Mellema
authors.affiliation: Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Ring
keywords: Clavicle; Computed tomography; Distance; Fracture; Vital structures