What Is a Subclavian Line?

The clavicle (English: Clavicle; Latin: Clavicula) is one of the three bones of the scapulae of reptiles, birds, and mammals. Bonefish already has its marks on it, tailed amphibians still have no clavicle, and tailless amphibians have clavicle. In addition to the clavicle, there are coracoids and scapula, which together form the scapular strap.

The clavicle (English: Clavicle; Latin: Clavicula) is one of the three bones of the scapulae of reptiles, birds, and mammals. Bonefish already has its marks on it, tailed amphibians still have no clavicle, and tailless amphibians have clavicle. In addition to the clavicle, there are coracoids and scapula, which together form the scapular strap.

Chinese name

clavicle

Foreign name

Clavicle

Latin

Clavicula

Make up shoulder straps

Clavicle, beak, scapula

Clavicle I. Anatomy

It is a component of the upper extremity band. It is an "S" shaped slender bone that connects the scapula and the sternum. It is placed horizontally above the thorax and is located under the skin. Its entire length can be touched. The clavicle has no bone marrow cavity. It is the first ossified bone in the fetus, and it is the bone formed into the membrane.

The clavicle is the bone connected to the central axis bone in the upper limb. It acts as a brace, supporting the upper limb away from the torso, expanding the field of vision of the person, increasing the range of movement of the upper limb, and improving the work efficiency of the upper limb.

The blunt circle of the medial clavicle is called the sternal end, and it is related to the clavicle notch of the sternal stem. The lateral width is called the acromion, which is related to the acromion of the scapula. The lateral 1/3 of the clavicle is flat and convex upward and backward, and the medial 2/3 is triangular and convex forward. The top is smooth and the bottom is rough.

The clavicle is the bone with the most frequent fractures in the body. The interface between the middle 1/3 and the outer 1/3 of the clavicle is the weakest part. When a person falls to the shoulder or hands, the violence transmitted to the trunk is greater than the strength of the weak bone, and a fracture occurs.

The length of the clavicle in Chinese is 14.6 to 14.7 cm for men and 12.9 to 13.3 cm for women.

Clavicle (right)

Clavicle II. Related diseases and treatment

Clavicle fractures are one of the most common fractures, accounting for 2.6% to 12% of all fractures. In adults, 2% to 5% of fractures involve the clavicle, while in children, the proportion is as high as 10% to 15%. Among clavicle fractures, mid-fracture fractures account for 80% of all fractures, while inner 1/3 and outer 1/3 account for 5% and 15% of clavicle fractures, respectively. The inner third of the clavicle protects the deep brachial plexus nerves, subclavian veins, axillary veins, and apical lungs, and other important organs. Fractures at this site can be combined with serious complications such as brachial plexus injuries.

Clavicle fractures are divided into three types: type is a middle 1/3 fracture, type is an external 1/3 fracture, and type is an internal 1/3 fracture.

1 Proximal clavicle fractures Proximal clavicle fractures are usually treated conservatively. This type of fracture is uncommon clinically, usually with a small displacement of the fracture end and rarely involving the sternoclavicular joint. However, when the posterior displacement of the fracture block is obvious, the fracture block protrudes into the neck root or the mediastinum, and the fracture block has the risk of compressing the blood vessels and nerves in the neck root and multiple injuries or floating shoulders need to be opened or closed for reduction.

2 Mid-clavicular fractures Most mid-clavicular fractures can be treated with forearm slings or "8" bandages. Conservative treatment is still the main treatment for non-displaced fractures of the middle clavicle. Indications for surgical treatment of mid-clavicular fractures are: open fractures; fractures with subclavian neurovascular injury; obvious displacement, and skin bulges are likely to develop fractures; ipsilateral clavicle and scapula fractures (floating shoulder); removal The position exceeds the clavicle diameter or shortens more than 2cm. There is much controversy in China about the choice of treatment methods for mid-clavicular fractures. Conservative treatment can be tried for non-displaced mid-clavicular fractures, which rarely affects the function and aesthetics of patients after surgery. However, it is recommended that surgical treatment be performed for displaced midclavicular fractures. Because of the conservative treatment of displaced mid-clavicular fractures, shoulder deformities, shoulder dysfunction, and nonunion are likely to cause complications.

3 distal clavicle fractures For non-displaced distal clavicle fractures, conservative treatment can be selected. Most fractures of the distal clavicle 1/3 are non-displaced or slightly displaced, and are located outside the joint. Therefore, non-surgical treatment of the distal clavicle 1/3 fracture is usually selected. Whether the operation depends on the degree of displacement of the fracture end, stability and the age of the patient. Many internal fixation techniques have been used to treat distal clavicle fractures, such as Kirschner wire fixation, coracoclavicular screw fixation, clavicle plate and clavicle plate hook. However, each technique has corresponding defects, which limits its clinical application. Most Kirschner wires cannot resist the gravity of the drooping of the upper limbs and are easily bent, slipped, or even broken; if the Kirschner wires do not pass through the medial cortex of the fracture, they are not fixed securely and slip easily, with a slip rate of up to 50%; Stimulating nearby tissues causes pain and affects functional exercise.

Techniques of open reduction and internal fixation include plate internal fixation and intramedullary fixation. 1. Steel plate internal fixation technology can achieve early rigid fixation of fracture end, which is helpful for patients' early activities. The supraclavicular plate has the risk of damaging the subclavian neurovascular structure, while the preclavicular plate and intramedullary nails do not have this risk. 2. The elastic intramedullary nail is used to treat adolescent clavicle fractures, which has good effect, small trauma, and reliable fixation, and provides a reliable choice for the treatment of adolescent clavicle fractures.

The failure of early internal fixation after a clavicle fracture is due to the poor stability of the internal fixation, which can be treated by replacement of the internal fixation; and the late failure is caused by non-healing of the fracture. Autogenous sacrum bone graft. Multiple operations may cause mild shoulder pain and dysfunction. Therefore, internal fixation should be reasonably selected according to the fracture type for surgical treatment of clavicle fractures, and blood flow at the fracture end should be protected during surgery to reduce the incidence of internal fixation failure after surgery.