After completion of this session, students should be able to discuss, identify, and describe: The anatomical factors predisposing to the etiology of a fracture or dislocation. The anatomy of displacement or deformity. Imaging anatomy features and how to differentiate from epiphyseal lines. Anatomy related to correct relocation and alignment. Anatomical complications of a fracture or dislocation.

1. Dr.AkramJaffar
Imaging Anatomy of Fractures and Dislocations inImaging Anatomy of Fractures and Dislocations in
the Upper Limbthe Upper Limb
Fracture of the clavicleFracture of the clavicle
Akram Jaffar, Ph.D.
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2. Dr.AkramJaffar
References and suggested reading
• Ellis H (2006): Clinical anatomy, A revision and applied anatomy for clinical students.
11th
Ed. Blackwell Publishing. Massachusetts.
• Moore KL et al. (2013): Clinically Orientated Anatomy. 7th Ed. Lippincott, Williams &
Wilkins. Philadelphia.
• Hamblen DL & Simpson HRW (2007): Adam’s outline of fractures including joint
injuries. 12th
ed. Churchill Livingstone Elsevier. Edinburgh.
• Solomon L, Warwick DJ & Nayagam S (2001): Apley's System of Orthopedics and
Fractures. 8th ed. Arnold Publishing.

3. Dr.AkramJaffar
Objectives
After completion of this session, students should be able to discuss, identify, and
describe:
• The anatomical factors predisposing to the etiology of a fracture or dislocation.
• The anatomy of displacement or deformity.
• Imaging anatomy features and how to differentiate from epiphyseal lines.
• Anatomy related to correct relocation and alignment.
• Anatomical complications of a fracture or dislocation.

4. Dr.AkramJaffar
Fracture of the clavicle
• Function of the clavicle:
– Transmit forces from the upper
limb to the axial skeleton.
– Acts as a strut holding the arm free
from the trunk to hang supported
principally by trapezius.
– Provides attachment for muscles.
trapezius
deltoid
Pectorais major
sternocleidomastoid

5. Dr.AkramJaffar
Fracture of the clavicle
• Common site: at the junction of the middle and lateral thirds (weakest point)
• Anatomy of displacement:
– Trapezius is unable to support the weight of the arm  The shoulder sags
slightly owing to the weight of the limb.
– Pectoralis major adducts and medially rotates the upper limb.
– Sterocleidomastoid elevates the inner fragment.
weight
Pectoralis major
sternocleidomastoid
Pectoralis major
Coracoid
process
acromion

6. Dr.AkramJaffar
Fracture of the clavicle
• Anatomical complications:
– Vascular and nerve injury may
complicate fracture of the clavicle.
– Subclavius may prevent the jagged
ends of a fractured clavicle from
damaging the adjacent subclavian vein.
Axillary a.
Axillary v.
Brachial plexus
subclavius

7. Dr.AkramJaffar
Fracture of the clavicle
• In spite of the superficial location of
the clavicle, piercing of the skin
(compound fracture) is rare. This
is attributed to the subcutaneous
location of the platysma, which
allows the skin to move freely over
the clavicle and protects the skin.
platysma

8. Dr.AkramJaffar
Ossification of the clavicle
• First bone to ossify, last epiphysis to
be closed.
• The clavicle is the first bone to ossify
in the body; membranous ossification
• A secondary ossification center at the
sternal end forms a scale-like
epiphysis that is completely fused at
25 years.
• A smaller scale-like epiphysis may be
present at the acromial end of the
clavicle.
• The secondary ossification centres
must not be mistaken for a fracture.
Sternal end

9. Dr.AkramJaffar
Fracture of the clavicle
• Fracture of the clavicle in the newborn:
– Is more frequent than all other birth
fractures combined.
– During difficult delivery either by the hand
of the obstetrician or by being pressed
against the maternal symphysis pubis.

10. Dr.AkramJaffar
Fracture of the clavicle
• Fracture of the clavicle in the newborn:
– Is more frequent than all other birth
fractures combined.
– During difficult delivery either by the hand
of the obstetrician or by being pressed
against the maternal symphysis pubis.