MyMedR

Fulltext Open traumatic scapulothoracic dissociation: Case report of a rare injury

Anbarasan A, Mohamad NH, Mariapan S

Trauma Case Rep, 2018 Dec;18:42-45.

PMID: 30533482 DOI: 10.1016/j.tcr.2018.11.013

Open traumatic scapulothoracic dissociation is a rare and devastating injury. We are reporting a 21-year-old male factory worker who sustained a traumatic open scapulothoracic dissociation. His left arm was caught in conveyer belts resulting the arm, scapula, clavicle, and pectoral muscle torn from the body by tremendous traction force. He presented with pulseless, flail and cold limb and was promptly resuscitated and surgically managed with forequarter amputation.

Matched MeSH terms: Clavicle

Fulltext Bipolar clavicular injury

Pang KP, Yung SW, Lee TS, Pang CE

Med J Malaysia, 2003 Oct;58(4):621-4.

PMID: 15190643

While clavicular injuries are fairly common, bipolar clavicular injuries are not. They may involve dislocations at both ends of the clavicle, or a fracture at one end and a dislocation at the other. We present two cases; a patient with a bipolar clavicular dislocation, and another with a fracture in both medial and lateral ends of the clavicle with anterior dislocation of the sternoclavicular joint. Both were treated conservatively, with fairly good range of motion and return to normal activity.

Matched MeSH terms: Clavicle/injuries*; Clavicle/radiography

Fracture of the first rib with associated fracture of the clavicle

Iqbal QM

Med J Malaya, 1971 Mar;25(3):223-5.

PMID: 4253253

Matched MeSH terms: Clavicle/injuries*

Axillary artery thrombosis associated with fracture of the clavicle

Iqbal QM

Med J Malaya, 1971 Sep;26(1):68-70.

PMID: 4258581

Matched MeSH terms: Clavicle/injuries*

Fulltext Clavicle fracture and subclavian vessels disruption with massive haemothorax mimic intrathoracic injury

Faisham WI, Mohammad P, Juhara H, Munirah NM, Shamsulkamaruljan H, Ziyadi GM

Malays J Med Sci, 2011 Apr;18(2):74-7.

PMID: 22135591

We report a case of open fracture of the clavicle with subclavian artery and vein laceration and perforation of the parietal pleural below the first rib that caused massive haemothorax. Emergency thoracotomy and exploration followed by repair of both vessels were able to salvage the patient and the extremity.

Matched MeSH terms: Clavicle

Fulltext Sternocleidohyoid muscle: an unreported variant of cleidohyoid muscle

Nayak SB, Shetty SD

Surg Radiol Anat, 2021 Aug;43(8):1327-1330.

PMID: 33527215 DOI: 10.1007/s00276-021-02682-0

Sternohyoid, sternothyroid, omohyoid, and thyrohyoid muscles are collectively known as infrahyoid muscles. These muscles frequently show variations in their attachments. Here, an extremely rare variant muscle belonging to this group has been presented. During cadaveric dissection for undergraduate medical students, an additional muscle was found between sternohyoid and superior belly of omohyoid muscles bilaterally in a male cadaver aged approximately 70 years. This muscle took its origin from posterior surface of the manubrium sterni, capsule of the sternoclavicular joint and the posterior surface of the medial part of the clavicle. It was inserted to the hyoid bone between the attachments of sternohyoid and superior belly of omohyoid muscles and was supplied by a branch of ansa cervicalis profunda. There is no report on such a muscle in the literature and it could be named as "sternocleidohyoid muscle". Knowledge of this muscle could be useful in neck surgeries.

Matched MeSH terms: Clavicle/abnormalities

Does Leveling the Upper Thoracic Spine Have Any Impact on Postoperative Clinical Shoulder Balance in Lenke 1 and 2 Patients?

Amir D, Yaszay B, Bartley CE, Bastrom TP, Newton PO

Spine (Phila Pa 1976), 2016 Jul 15;41(14):1122-1127.

PMID: 26863257 DOI: 10.1097/BRS.0000000000001497

STUDY DESIGN: Retrospective review of prospective data.

OBJECTIVE: To determine if surgically leveling the upper thoracic spine in patients with adolescent idiopathic scoliosis results in level shoulders postoperatively.

SUMMARY OF BACKGROUND DATA: Research has shown that preoperatively tilted proximal ribs and T1 tilt are more correlated with trapezial prominence than with clavicle angle.

METHODS: Prospectively collected Lenke 1 and 2 cases from a single center were reviewed. Clinical shoulder imbalance was measured from 2-year postoperative clinical photos. Lateral shoulder imbalance was assessed utilizing clavicle angle. Medial imbalance was assessed with trapezial angle (TA), and trapezial area ratio (TAR). First rib angle, T1 tilt, and upper thoracic curve were measured from 2-year radiographs. Angular measurements were considered level if ≤ 3° of zero. TAR was considered level if ≤ 1 standard deviation of the natural log of the ratio. Upper thoracic Cobb at 2-years was categorized as at or below the mean value (≤ 14°) versus above the mean.

RESULTS: Eighty-four patients were identified. There was no significant difference in the percentage of patients with a level clavicle angle or TAR based on first rib being level, T1 tilt being level, or upper thoracic Cobb being at/below versus above the mean (P

Matched MeSH terms: Clavicle/surgery*

A Positive (+ve) Postoperative Upper Instrumented Vertebra Tilt Angle (≥0°) Significantly Increases the Risk of Medial Shoulder and Neck Imbalance in Lenke 1 and 2 Adolescent Idiopathic Scoliosis Patients

Kwan MK, Lee SY, Ch'ng PY, Chung WH, Chiu CK, Chan CYW

Spine (Phila Pa 1976), 2020 Jun 15;45(12):E694-E703.

PMID: 32032325 DOI: 10.1097/BRS.0000000000003407

STUDY DESIGN: Retrospective study.

OBJECTIVE: To investigate the relationship between a +ve postoperative Upper Instrumented Vertebra (UIV) (≥0°) tilt angle and the risk of medial shoulder/neck and lateral shoulder imbalance among Lenke 1 and 2 Adolescent Idiopathic Scoliosis (AIS) patients following Posterior Spinal Fusion.

SUMMARY OF BACKGROUND DATA: Current UIV selection strategy has poor correlation with postoperative shoulder balance. The relationship between a +ve postoperative UIV tilt angle and the risk of postoperative shoulder and neck imbalance was unknown.

METHODS: One hundred thirty-six Lenke 1 and 2 AIS patients with minimum 2 years follow-up were recruited. For medial shoulder and neck balance, patients were categorized into positive (+ve) imbalance (≥+4°), balanced, or negative (-ve) imbalance (≤-4°) groups based on T1 tilt angle/Cervical Axis measurement. For lateral shoulder balance, patients were classified into +ve imbalance (≥+3°) balanced, and -ve imbalance (≤-3°) groups based on Clavicle Angle (Cla-A) measurement. Linear regression analysis identified the predictive factors for shoulder/neck imbalance. Logistic regression analysis calculated the odds ratio of shoulder/neck imbalance for patients with +ve postoperative UIV tilt angle.

RESULTS: Postoperative UIV tilt angle and preoperative T1 tilt angle were predictive of +ve medial shoulder imbalance. Postoperative UIV tilt angle and postoperative PT correction were predictive of +ve neck imbalance. Approximately 51.6% of patients with +ve medial shoulder imbalance had +ve postoperative UIV tilt angle. Patients with +ve postoperative UIV tilt angle had 14.9 times increased odds of developing +ve medial shoulder imbalance and 3.3 times increased odds of developing +ve neck imbalance. Postoperative UIV tilt angle did not predict lateral shoulder imbalance.

CONCLUSION: Patients with +ve postoperative UIV tilt angle had 14.9 times increased odds of developing +ve medial shoulder imbalance (T1 tilt angle ≥+4°) and 3.3 times increased odds of developing +ve neck imbalance (cervical axis ≥+4°).

LEVEL OF EVIDENCE: 4.

Matched MeSH terms: Clavicle

Ultrasound-Guided Retroclavicular Block (aka Posterior Approach Infraclavicular Block): Anatomical Variation of the Clavicle Limits Block Feasibility

Beh ZY, Hasan MS, Lai HY

Reg Anesth Pain Med, 2016 8 23;41(5):658-9.

PMID: 27547909 DOI: 10.1097/AAP.0000000000000456

Matched MeSH terms: Clavicle*

The coracoclavicular joint

Cockshott WP

Radiology, 1979 May;131(2):313-6.

PMID: 441311

The coracoclavicular joints are genetically determined anatomic variants. There are problems in determining their presence by dissection examination of osteologic material as well as by radiography. Based on a survey of published material and a prospective radiological survey carried out in Malaysia, it is clear that the anomaly is more frequent in Asia than in Europe and Africa. There is a high incidence in people from Southern China. The joints are subject to osteophytic marginal lipping without development of symptoms or disability.

Matched MeSH terms: Clavicle/anatomy & histology; Clavicle/radiography*

Fulltext Arthroscopic resection of the distal clavicle with concomitant subacromial decompression: a case series

Chan H, Ooi C, Lim M, Ong E, Zulkiflee O

Malays Orthop J, 2014 Jul;8(2):59-62.

PMID: 25279097 MyJurnal DOI: 10.5704/MOJ.1407.007

Shoulder impingement syndrome and acromioclavicular joint osteoarthritis often occur simultaneously and easily missed. Kay et al. reported excellent results with combined arthroscopic subacromial decompression and resection of the distal end of the clavicle in patients with both disorders(1). Arthroscopic treatment of these disorders produces more favourable results than open procedures. We report two patients who were not responding to conservative management and were treated with direct arthroscopic distal clavicle excision and subacromial decompression in single setting. Both patients gained good postoperative outcome in terms of pain score, function and strength improvement assessed objectively with visual analogue score (VAS) and University of California Los Angeles Score (UCLA).

Matched MeSH terms: Clavicle

Fulltext Shoulder impingement, an uncommon complication of distal clavicle fracture treated arthroscopically: a case report

Wang C, Bea K, Zulkiflee O

Malays Orthop J, 2013 Nov;7(3):18-20.

PMID: 25674302 MyJurnal DOI: 10.5704/MOJ.1311.002

Clavicle fracture is commonly treated conservatively. However uncommon complication can arise causing impingement. We report a patient who sustained distal clavicle fracture and was treated conservatively. However he developed persistent shoulder pain that affected his daily life. Shoulder impingement was diagnosed and arthroscopic subacromioclavicular decompression was done. Following early physiotherapy the early recovery was good with full range of motion of the shoulder.

Matched MeSH terms: Clavicle

Fulltext Traumatic floating clavicle: a case report

Choo C, Wong H, Nordin A

Malays Orthop J, 2012 Nov;6(3):57-9.

PMID: 25279061 MyJurnal DOI: 10.5704/MOJ.1207.008

Shoulder girdle injuries after high energy traumatic impacts to the shoulder have been well documented. Based on the series of 1603 injuries of the shoulder girdle reported by Cave and colleagues, 85% of the dislocations were glenohumeral, 12% acromioclavicular and 3% sternoclavicular (1). Less frequently described are injuries involving both the sternoclavicular and acromioclavicular joints simultaneously in one extremity. The present report discusses a case of traumatic floating clavicle associated with ipsilateral forearm and wrist injury which was treated surgically.

Matched MeSH terms: Clavicle

Fulltext Non-bacterial chronic recurrent osteomyelitis of the clavicle

Pan K, Chan W, Ong G, Zulqarnaen M, Norlida D

Malays Orthop J, 2012 Mar;6(1):57-60.

PMID: 25279046 MyJurnal DOI: 10.5704/MOJ.1203.005

This report details the case of a 12-year-old girl with a painful, progressive swelling of the medial portion of the clavicle with no history of trauma or other constitutional symptoms. All laboratory investigations were normal except for an elevated erythrocyte sedimentation rate (ESR). Initial plain radiographs showed a destructive lesion with magnetic resonance imaging showing features of malignancy. Biopsies revealed osteomyelitis, but with negative bacterial cultures and no evidence of malignancy. Treatment with antibiotics did not result in a favourable response. Over time, the swelling increased in size with episodic exacerbations of pain. Follow-up radiographs showed sclerosis and hyperostosis. After five years, this was recognized as non-bacterial chronic recurrent osteomyelitis of the clavicle.

Matched MeSH terms: Clavicle

Fulltext A technique of distal clavicle fracture fixation using the tightrope procedure

Soh C, Sivapathasundaram N, Parthiban R, Ramanand A

Malays Orthop J, 2011 Nov;5(3):20-3.

PMID: 25279031 MyJurnal DOI: 10.5704/MOJ.1111.002

We present here a technique of fracture stabilization using the Tightrope procedure in a patient with a widely displaced Neer type IIB distal clavicle fracture. The Tightrope system, typically used for stabilization of acromioclavicular joint dislocation, has not been widely described for distal clavicle fractures. The patient achieved satisfactory results after surgery; we feel that this technique is appealing as it is simple, reproducible and avoids the complications associated with extensive metalwork. This technique may also appeal to the arthroscopic surgeon.

Matched MeSH terms: Clavicle

Graft and Button Modification of Technique of Coracoclavicular Joint Reconstruction in Treatment of Chronic Type V Acromioclavicular Joint Dislocation: A Case Report

Leong YC, Muhammad-Suhairi J

Malays Orthop J, 2019 Jul;13(2):45-48.

PMID: 31467652 DOI: 10.5704/MOJ.1907.009

Treatment of chronic Rockwood's type V Acromioclavicular (AC) joint dislocation remains controversial. We describe a surgical technique to reduce and maintain AC joint using a combination of gracilis autograft with GraftMax™ button (Conmed Inc, Utica, NY). Graft was prepared using running whip stitch technique with No. 5 Hi-Fi high strength suture (ConMed Linvatec, Largo, FL). Our technique reduces intraoperative clavicular and coracoid tunnel fracture and restores anatomical coracoclavicular ligament. At sixth week and third month postoperatively, the patient demonstrated good clinical and radiographic outcome.

Matched MeSH terms: Clavicle

Fulltext A New Technique for Solving Tightrope Cutout during Acromioclavicular Joint Fixation: A Case Report

Ng BW, Abdullah AF, Nadarajah S

Malays Orthop J, 2017 Mar;11(1):57-59.

PMID: 28435576 MyJurnal DOI: 10.5704/MOJ.1703.003

Acromioclavicular joint (ACJ) dissociation is one of the common injuries affecting adults. The stability of ACJ largely depends on the integrity of acromioclavicular ligament, coracoclavicular ligament, capsule, trapezius muscle and deltoid muscle. The injury has been classified by Rockwood into six types and treatment options can be guided by the classification. TightRope fixation is one of the many surgical procedures available to address acromioclavicular joint separation. It consists of tensioning of a no. 5 Fibrewire suture secured at both ends to low-profile metallic buttons. Despite various advantages of using this technique, complications such as suture cut-out, clavicle fracture and suture failure have been documented. The author presents a case of a type III acromioclavicular joint dissociation treated with TightRope which suture cutout was noted intra-operatively. Decision to amend the fixation using a cut one-third tubular plate as an additional anchor for the metallic button on the clavicle was made. Patient's progress was evaluated using the University of California at Los Angeles Shoulder Score (UCLA Shoulder Score) and significant improvement was noted six months post operatively. We propose this technique as a solution to the encountered problem.

Matched MeSH terms: Clavicle

Fulltext Multidrug Resistant Tuberculosis involving the Clavicle, Spine and Ribs

Malays Orthop J, 2011;5(1):71-74.

MyJurnal

This report describes an unusual case of multidrug resistant tuberculosis (MDR-TB), involving the right clavicle and multicentric aytpical spine involvement without any neurological deficit. The female patient presented with acute onset of right clavicular pain associated with a one-monthhistory of lower backache with constitutional symptoms. The clavicular lesion and MRI spine findings were highly suggestive of TB. Anti TB drugs (ATD) were started empirically as Sabah, Malaysia the patient’s home, is anendemic area for TB. Despite, 2 months of ATD administration, the patient did not respond well clinically and developed left sided chest wall abscesses arising from the left 3rd and 6th ribs. She was then treated for MDR-TB infection and has responded well to this treatment.

Matched MeSH terms: Clavicle

Fulltext Kirschner Wire Migration to the Cervical Spine: A Complication of Clavicular Fixation in a Child

Tan, K.K., Ibrahim, S.

Malays Orthop J, 2007;1(1):45-46.

MyJurnal

We report a case of a broken K-wire migrating to the cervical spine from the right clavicle in a 9-year-old child. The initial diagnosis, fracture of the clavicle with an acromioclavicular joint dislocation, was treated by open reduction and K-wiring. One K-wire broke and migrated to the neck, posterolateral to the C6 vertebra. The K-wire was removed percutaneously under image intensification. Acromioclavicular joint dislocation in children is rare since the distal clavicle does not ossify until the age of 18 or 19 years meaning that almost all closed fractures of the clavicle in children can be treated nonoperatively.

Matched MeSH terms: Clavicle

Fulltext Precontoured Clavicular Locking Plate with Broad Lateral End: A Newly Designed Plate for Lateral Third Clavicle Fractures

Kapil-Mani KC, Acharya P, Arun S

Malays Orthop J, 2018 Mar;12(1):15-20.

PMID: 29725507 DOI: 10.5704/MOJ.1803.003

Introduction: Various treatment modalities are available but no consensus has been reached for optimal treatment of lateral third clavicle fractures. Precontoured locking plates with broad lateral end for multiple screws fixation is a newly designed plate for lateral third clavicle fractures. The objective of our study was to analyse the functional outcomes as well as complications of this technique in a significant number of cases with long follow-up duration. Materials and Methods: Forty-six patients with distal third clavicle fractures were treated by precontoured clavicular locking plate with broad lateral end. Functional outcomes were assessed on the basis of Constant-Murley Shoulder Outcome Score and University of California, Los Angeles (UCLA) Shoulder Rating Score, active shoulder range of motion, time for fracture union and coraco-clavicular distance. Results: The mean Constant-Murley score was 92.56±4.47 (range: 79-98) for injured side and 96.22±2.23 (range: 90-100) for normal side with p-Value 0.56. Mean coraco-clavicular distance at final follow-up was 10.52±1.13 mm (range 9.7 to 11.7 mm) in injured side and 10.25±0.98 mm (range 9.6 to 11.2 mm) in normal side. Mean UCLA Shoulder Rating Score was 32.55±2.12 (range: 27-34) for injured side and 33.46±1.88 (range: 31- 35) on normal side with p value 0.58. No major complications that necessitated revision of surgery occurred in our study. Conclusion: This newly designed plate seemed extremely useful in successful union of lateral third clavicle fractures, with reduced rate of complications like fixation failures, iatrogenic rotator cuff injury, AC joint osteoarthritis and sub-acromial bursitis, with good functional outcomes.

Matched MeSH terms: Clavicle

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