A comprehensive, integrated study of the clavicle: Its topographical anatomy, biomechanical architecture and function; pathological anatomy of mid-shaft fractures and the decision-making process for a surgical approach : when planning an intramedullary implant: Parts 1-9

Gandhi  Harjeet Singh

doi:10.24297/ijct.v26i.9857

Authors

Gandhi Harjeet Singh Orthopaedic surgeon, Honorary Staff, Hamilton Health Sciences, Hamilton, ON, Canada

DOI:

https://doi.org/10.24297/ijct.v26i.9857

Keywords:

Phylogeny and Ontogeny, Intramedullary clavicle implant, Scapular dyskinesis, Hyperbolic paraboloid architecture, Clavicle torsion and version, Biomechanics, Clavicle morphometry, Clavicle fracture and malunion, Clavicle anatomy

Abstract

The modernization of the clavicle is a continuous evolutionary process. It has been redesigned many times to its current form and function as the key link in the forelimb anatomy and director of the scapula to position the glenoid fossa under the head of the humerus. The clavicle bone is a forerunner to the development of the skeleton from its embryonic days, and it reaches maturity last of all for a special reason. Its intricate biomechanical architecture has evolved in tandem with the emergence of the erect human posture and bipedalism, and the postcranial elongation of the neck to facilitate a forward-facing horizontal gaze, necessitating a significant reorientation of the pectoral girdle musculature.

Modern lifestyles, both at work and during leisure, have led to trauma with varied disruptions in the continuity of the clavicle, resulting in simple and severely comminuted fractures across all age groups, with a bimodal distribution. In very young individuals, with greater potential for linear growth and limited remodelling, conservative treatment is acceptable. However, beyond mid-adolescence, the growth potential and remodelling are minimal. Therefore, to prevent malunion and dysfunction, the clavicle’s anatomy and biomechanical architecture must be fully restored to re-establish the patient-specific kinematics, as it plays a crucial role in the normal functioning of the pectoral girdle and the humerus.

This comprehensive nine-part study includes the topographic anatomy of the clavicle, an explanation of its unique biomechanical architecture, and the pathological anatomy of mid-diaphyseal fractures, malunion, and its complications. When and why choose the antegrade or retrograde approach for the insertion of an intramedullary implant? Finally, the newly conceived three intramedullary implant designs for the reduction and biological fixation of the mid-diaphyseal fractures of the clavicle are presented. The study is illustrated with several cadaveric dissections performed by the author, anatomy artwork, and sketches created in PowerPoint.

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