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Significance of Clavicle Morphology in Acute Clavicle Fractures
Rhiana Rivas, BS
1, Elizabeth Muhammad, BS
2, Ana Love, BS
1, Ann L Wells, PhD
1, Julie Mekhail, MS
3, Jorge Orbay, MD
4; Deana Mercer, MD
5(1)University of New Mexico School of Medicine, Albuquerque, NM, (2)Burrell College of Osteopathic Medicine, Las Cruces, NM, (3)Rosalind Franklin University of Medicine and Science, Chicago, IL, (4)Miami Bone Institute, Miami, FL, (5)University of New Mexico, Albuquerque, NM
Introduction: Surgical management for clavicle fractures has gained more momentum in the past two decades due to emerging data demonstrating lower non-union rates amongst patients who are managed surgically compared to those who are managed conservatively. As a result of this phenomenon, there is a renewed interest in understanding clavicular morphology. We hypothesize that most fractures occur around a specific point of inflection point that is defined by the transition point between the lateral and medial arc of the clavicle. By further specifying the clavicle's point of weakness or propensity to fracture, the orthopedic surgeon's fixation approach may be optimized, and the design of pre-contoured clavicle plates may be refined.
Methods: 115 patients with confirmed unilateral clavicle fractures on computed tomography (CT) were identified at UNMH. A retrospective chart review was conducted to discern fracture location, laterality, mechanism of injury, age and gender. The corresponding patient CT Chest was modeled in three-dimensional software and underwent subsequent image processing to derive the corresponding 4
th-degree polynomial equation from the clavicular center line. Key morphometric variables were then derived from the corresponding equation of each clavicle and analyzed. The fracture distance was also analyzed and compared.
Results: Group I (midshaft) fractures were the most common fractures with a prevalence of 78.26%, Clavicular fractures were more prevalent in males than females, and males also tended to have longer clavicles on average. There was no significant difference in radius of curvature or medial or lateral angles between males and females. The point at which the medial arc transitioned to the lateral arc was on average 61% of the total clavicular length when measured from the medial border. When fracture distance was measured, the average distance from the medial border corresponded to 60% of the total clavicular length.
Conclusions: Most fractures are midshaft fractures and occur at a location that is 60% of the total clavicular length when measured from the medial border. This location correlates significantly to the anatomical inflection as derived mathematically from morphometric analysis. The inflection point of the clavicle can be defined anatomically. Surgeons should utilize this knowledge in clavicle fracture fixation, particularly with respect to midshaft fractures.
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