Pectoral Girdle Fractures

Published on 16/04/2015 by admin

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Last modified 22/04/2025

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20 Pectoral Girdle Fractures

Anatomy of the Pectoral Girdle

image

Shoulder Bones and Ligaments

image

Clavicle

Clavicle

• Parts and landmarks: sternal end/facet, impression for costoclavicular ligament, shaft (body), conoid tubercle, trapezoid line, subclavian groove, acromial end/facet

Scapula

• Parts: glenoid fossa (cavity) supraglenoid tubercle, infraglenoid tubercle, neck, coracoid process, suprascapular notch, superior border, superior angle, medial border, inferior angle, lateral border, subscapular fossa, spine, acromion, supraspinous fossa, infraspinous fossa

Pectoral Girdle and Shoulder Joints

• Sternoclavicular joint

image Synovial, with articular disc (dual axes of movement)
image Extremely strong: only joint attaching upper-limb girdle to the axial skeleton

• Acromioclavicular (AC) joint

image Synovial, gliding/plane
image Supported by acromioclavicular ligament
image Acts as a pivot point to increase range of arm motion (raise arm over head)

• Glenohumeral joint (also covered in Chapter 21, Humerus Fractures)

image Synovial, ball and socket with labrum
image Basis for upper limb positioning and transmission of forces to pectoral girdle
image Involved in glenoid fractures (intraarticular)
image Biceps (long) tendon inserts on supraglenoid tubercle
image Triceps (long) tendon inserts on infraglenoid tubercle

Ligaments

• Coracoclavicular ligament

image Very strong, two-part
image Shares forces between clavicle and scapula
image Trapezoid: nearly horizontal, attaches to conoid tubercle and superior surface of coracoid
image Conoid: nearly vertical inverted triangle, attaches to coracoid root
image Parts may be separated by bursa.
image Base for supporting scapula and upper limb on the clavicular “strut”

• Acromioclavicular ligament: strengthens AC joint superiorly
• Coracoacromial ligament: limits superior displacement of humeral head
• Costoclavicular ligament

image Strong
image Attaches near head of clavicle to 1st costal cartilage
image Reinforces sternoclavicular joint, prevents displacement of clavicle

Neurovascular Supply

image

Subclavian and Axillary Artery Anastomoses

Arterial Supply

• Subclavian artery provides numerous branches, forming anastomoses around the scapula, glenohumeral joint, and proximal humerus.

image Dorsal scapular artery

image Runs from base of neck along vertebral border of scapula
image Anastomoses with medial suprascapular branches

image Suprascapular artery

image From mid-subclavian to scapula above transverse scapular ligament, above suprascapular notch
image Has supraspinous and infraspinous branches to respective fossae

image Axillary artery

image Thoracoacromial artery
image Posterior humeral circumflex artery (in quadrangular space)
image Subscapular artery, circumflex scapular branch; anastomoses with dorsal scapular and suprascapular branches

Venous Drainage

• Veins of pectoral and scapular regions run parallel to the subclavian and axillary arteries and their major branches: valved, arterial counterpulsation effect pumps blood.
• Superficial tributaries

image Cephalic vein: travels superficial to biceps to empty into axillary vein
image Basilic vein: from superficial forearm and distal arm, empties into axillary vein

• Deep tributaries

image Axillary vein

image Brachial vein

• Axillary vein continues into subclavian vein.
• Axillary vein lies superficial to axillary sheath and parts of brachial plexus.
• Dorsal scapular veins drain into scapular circumflex, subscapular (axillary) tributaries, and dorsal scapular suprascapular (subclavian) tributaries.

Nerves

Brachial Plexus

• Vital nerves for upper limb pass deep to clavicle.
• Roots

image C5-T1 anterior rami, arise in the neck at the levels of their vertebral foramina
image Supraclavicular level

• Trunks

image Superior (C5, C6), middle (C7), inferior (C8-T1) arise from union of roots
image Supraclavicular level
image Nerve to subclavius: off superior trunk
image Suprascapular nerve: to supraspinatus and infraspinatus; off superior trunk

• Divisions

image Anterior and posterior portions of each trunk
image Clavicular level: at risk in medial fractures

• Cords: infraclavicular level

image Lateral: anterior divisions of superior and middle trunks
image Medial: anterior divisions of inferior trunk
image Posterior: posterior divisions only of all 3 trunks

• Terminal nerve branches: infraclavicular level
• See Chapter 21, Humerus Fractures, for more information

Clinical Correlates

image

Clavicular Fractures

Scapula Fractures

• Uncommon, <1% of all fractures
• Typically associated with other injuries
• Historically treated with closed reduction, with poor results with displacement
• Types: acromial, coracoid
• Glenoid fractures (Ideberg types)

image Type I: anterior avulsion
image Type II: transverse/oblique through glenoid, inferior exit
image Type III: oblique through glenoid, superior exit
image Type IV: transverse fracture through scapular body
image Type V: types II + IV

Clavicle Fractures

• Typically result from a direct fall onto the shoulder
• Most commonly involve the middle third
• Typically stable and tend to heal well with low risk of non-union
• High-energy injuries and open fractures more commonly associated with non-union and neurovascular injury (e.g., to subclavian artery or brachial plexus)

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