The role of muscle integrity following midshaft clavicular resections: a cadaveric study
İzge Günal1, Dinç Özaksoy2, Candan Arman3, Esat Kiter4, Hasan Tatari1, Vasfi Karatosun1
1Departments of Orthopedics and Traumatology,Medicine Faculty of Dokuz Eylül University, İzmir
2Departments of Diagnostic Radiology, Medicine Faculty of Dokuz Eylül University, İzmir
3Departments of Anatomy, Medicine Faculty of Dokuz Eylül University, İzmir
4Department of Orthopedics and Traumatology, Medicine Faculty of Pamukkale University, Denizli
Keywords: Clavicle/injuries/surgery; osteotomy/adverse effects; periosteum/surgery; shoulder fractures/surgery.
Abstract
Objectives: There are conflicting reports in the literature regarding midshaft clavicular resections, and the role of muscle integrity has not been studied before. This cadaveric study was designed to investigate the effects of the integrity of muscles after midshaft clavicular resections. Materials and methods: In an experimental design, seven fresh cadaver shoulders were used. After resection of 1.5 cm of the clavicle, the trapezius, sternocleidomastoid, deltoid, pectoralis major, and subclavius muscles were detached in five combinations from none to all and with or without the subclavius muscle included. Graded radiographs were taken to measure the movements of the fragments during abduction, flexion, and extension of the shoulder. Measurements were repeated three times for each procedure.
Results: Preservation of all muscle attachments to the clavicle resulted in no abnormal coronal plane motion at the osteotomy site. Similarly, no significant motion in the coronal plane was observed upon detachment of the four muscles with the subclavius muscle being intact. However, detachment of the subclavius muscle alone or in combination with the other muscles resulted in abnormal motion between the fragments.
Conclusion: The subclavius muscle appears to be the only structure preventing independent movement of the fragments; thus, special care should be taken to maintain the integrity of the subclavius muscle after midshaft clavicular resections.