An apical or lordotic view may then provide greater detail of the lung apices.Ĭhest x-rays are correctly aligned if the medial ends of clavicles are equidistant from the spinous process of vertebrae at the T4/5 level. On a chest x-ray image, the clavicles are superimposed over the apex of both the lungs and obscure the subtle lesions. Supraclavicular foramen: the clavicle may be pierced by a branch of supraclavicular nerveĪt the attachment of the costoclavicular (rhomboid) ligament, there may be a tuberosity or depression (rhomboid fossa) of variable size that may mimic disease a rhomboid fossa is more common in younger adults and males 4 The lateral end has intramembranous ossification. See main article: ossification centres of the pectoral girdle. It is also the last ossification centre to fuse, around 22-25 years of age. The infrequency of this injury has contributed to its diagnosis being missed as well as the paucity of literature. It is the first bone to start ossification at around 5th-6th weeks of gestation. Sternoclavicular joint (SCJ) instability is a rare condition and results from either a traumatic high energy impact, such as a motor vehicle crash or contact sports injury, or non-traumatically as a result of structural pathology. Nutrient branch from the suprascapular arteryĬlavicular branch of the thoracoacromial artery from the second part of the axillary artery acromioclavicular ligament, coracoclavicular ligament, sternoclavicular ligament, costoclavicular ligament, interclavicular ligament Pectoralis major, sternocleidomastoid (clavicular head), deltoid, trapezius, subclavius, sternohyoid The clavicle articulates with the acromion at the acromioclavicular joint laterally and the sternum at the sternoclavicular joint medially. The female clavicle is shorter, thinner, less curved and smoother than the male clavicle. On the inferior surface of the medial clavicle is the costal tuberosity and subclavian groove, which form the attachment sites for costoclavicular ligament and subclavius muscle, respectively. The shin (tibia), spine (vertebrae), collarbone (clavicle), and upper arm bone (humerus) are affected less commonly. On the inferior surface of the lateral third is the conoid tubercle for the attachment of the conoid ligament and lateral to this is the trapezoid line for attachment of the trapezoid ligament, both constituting the coracoclavicular ligament. The shaft connects the sternal (medial) end and the acromial (lateral) end. This is the American ICD-10-CM version of M84.522A - other international versions of ICD-10 M84.522A may differ. In addition, the treatment of the chronic form of clavicular osteomyelitis is surgical débridement and possible flap reconstruction.The clavicle is roughly "S-shaped" with a flattened, concave, lateral one-third and a thickened, convex, medial two-thirds. Short description: Pathological fracture in neoplastic disease, l humerus, init The 2024 edition of ICD-10-CM M84.522A became effective on October 1, 2023. ![]() To conclude, the surgeon should be aware that osteomyelitis of the clavicle can occur as a complication of head and neck procedures. Myocutaneous flaps were required in two patients who had had surgery and antecedent radiotherapy. Wide surgical débridement was the mainstay of treatment in the chronic conditions, with antibiotic therapy having a secondary role. Long-term intravenous antibiotic therapy (six to eight weeks) was used to successfully treat cases of hematogenously spread osteomyelitis. Four patients presented with acute symptoms resulting from hematogenous spread, and two of the four patients had Staphylococcus aureus on blood cultures. One case was related to a pharyngocutaneous fistula following a supraglottic laryngectomy. Six cases were associated with prior surgical procedures, and five cases presented as chronic wound drainage. The clavicle is vulnerable to pathological fractures from several causes such as neoplasm, infection and meta- bolic bone disease 3. Ten consecutive cases of the clavicular osteomyelitis were reviewed at the University of California Medical Center, Los Angeles, over the past seven years. Osteomyelitis of the clavicle is a rare entity and can occur as a complication of head and neck surgery.
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