Anterior Approach to the Clavicle indications:

Anterior Approach to the Clavicle is used for:

1. Open reduction and internal fixation of fractures
2. Reconstruction of the sternoclavicular and the acromioclavicular joints in case of dislocation
3. Drainage of sepsis
4. Biopsy and excision of tumors
5. Osteotomy for malunion

The brachial plexus and subacromial vessels can also be approached via this surgical approach. Osteotomy of the clavicle is required.

Clavicle Fractures

Clavicle Fractures

The clavicle fractures most often resulting from a direct blow or a fall on an outstretched arm, it’s one of the most frequently fractures in the body.
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Position of the Patient

  • Patient supine on the operating table.
  • Break the table and elevate the head end, so as to elevate the shoulder area.
  • Place a sandbag between the medial border of the scapula and the spine.

Landmarks and Incision

  • The sternal notch is the most medial landmark of the incision.
  • Make an incision following the S-shaped clavicular anatomy, beginning from the medial end.
Anterior Approach to the Clavicle
Skin incision

Internervous plane

  • There is no internervous plane because the approach is directly onto the subcutaneous surface of the clavicle.

Superficial dissection

  • Deepen the skin incision through the platysma to reach the subcutaneous surface of the clavicle.
Anterior Approach to the Clavicle
Dissection

Deep dissection

  • Gently strip soft tissues off the subcutaneous surface of the clavicle in an epi-periosteal plane.
Anterior Approach to the Clavicle
Deep dissection

Approach Extension

Dangers

  • The structures at risks in anterior approach to the clavicle are:
    1. Nerves: The brachial plexus.
    2. Vessels: The subacromial artery and vein.

References:

  • Surgical Exposures in Orthopaedics 4th Edition Book.