Anatomical Science International

, Volume 93, Issue 4, pp 479–486 | Cite as

Investigations of cortical and cancellous clavicle bone patterns reveal an explanation for the load transmission and the higher incidence of lateral clavicle fractures in the elderly: a CT-based cadaveric study

  • Satoshi Yamamura
  • Shogo Hayashi
  • Zhong-Lian LiEmail author
  • Shinichi Kawata
  • Philipp Pieroh
  • Kenta Nagahori
  • Takuya Omotehara
  • Hidenobu Miyaso
  • Masahiro Itoh
Original Article


Clavicle fracture is known to be one of the injuries frequently occurring in the elderly. The purpose of this study was to characterise the internal structures that might correlate with the higher incidence of lateral clavicle fracture in the elderly. Twenty clavicles were collected from ten Japanese cadavers ranging from 70 to 99 years (83.6 ± 7.6), scanned, and three-dimensional computed tomography (3D CT) images reconstructed. The clavicle lengths were divided into five equal segments. The four demarcation lines from the acromial end of the clavicle were defined as the observation points A, B, C, and D. The clavicles were then measured and analysed. It was shown that along the clavicles observation point A was the widest and points B and C the narrowest. Regarding the thickness, point D was the thickest among all four points, and there was no significant difference among the points A, B, and C. No male-female difference was found in either the cortical or cancellous bone ratio at all four points. Interestingly, the highest cortical bone ratio was observed at point B and the ratio was significantly decreased toward either end. The cancellous bone ratio was highest at point C and decreased toward both ends. Further observations showed that there were rays of trabeculae around point A, spreading from the superior-posterior edge or anterior edge toward each other and toward the lateral end and point B. Characteristics in the cortical and cancellous bone ratios and cancellous bone patterns might shed light on understanding the fractures in the lateral portion of the clavicle in the elderly.


Cancellous bone Clavicle Cortical bone Fracture Osteoporosis 



The authors would like to thank Ms. Kimiko Kimura for her assistance in preparing the first English manuscript and Ms. Yuka Kobayashi and Ms. Yuki Ogawa for their excellent secretarial assistance. All authors would like to extend our heartfelt thanks to the body donors and their families.

The present study is supported in part by a Grant-in-Aid for General Scientific Research from the Ministry of Education, Culture, Sports, and Technology of Japan (no. 17K01584).

Author contributions

SY, SH, and MI participated in the design of the present study. SY, SH, SK, KN, TO, and HM took part in the dissection of the cadavers. SY and SH were in charge of the data analysis and prepared the first draft of the manuscript. SY, ZL, PH, and MI composed the final version of the manuscript. All authors read and approved the final version of the manuscript.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.


  1. Aira JR, Simon P, Gutierrez S, Santoni BG, Frankle MA (2017) Morphometry of the human clavicle and intramedullary canal: a 3D, geometry-based quantification. J Orthop Res 35:2191–2202CrossRefPubMedGoogle Scholar
  2. Andermahr J, Jubel A, Elsner A, Johann J, Prokop A, Rehm KE, Koebke J (2007) Anatomy of the clavicle and the intramedullary nailing of midclavicular fractures. Clin Anat 20:48–56CrossRefPubMedGoogle Scholar
  3. Anton HC (1969) Width of clavicular cortex in osteoporosis. Br Med J 1:409–411CrossRefPubMedPubMedCentralGoogle Scholar
  4. Augat P, Schorlemmer S (2006) The role of cortical bone and its microstructure in bone strength. Age Ageing 35(Suppl 2):ii27–ii31CrossRefPubMedGoogle Scholar
  5. Bachoura A, Deane AS, Kamineni S (2012) Clavicle anatomy and the applicability of intramedullary midshaft fracture fixation. J Shoulder Elb Surg 21:1384–1390CrossRefGoogle Scholar
  6. Bachoura A, Deane AS, Wise JN, Kamineni S (2013) Clavicle morphometry revisited: a 3-dimensional study with relevance to operative fixation. J Shoulder Elb Surg 22:e15–e21CrossRefGoogle Scholar
  7. Bernat A, Huysmans T, Van Glabbeek F, Sijbers J, Gielen J, Van Tongel A (2014) The anatomy of the clavicle: a three-dimensional cadaveric study. Clin Anat 27:712–723CrossRefPubMedGoogle Scholar
  8. Buie HR, Campbell GM, Klinck RJ, MacNeil JA, Boyd SK (2007) Automatic segmentation of cortical and trabecular compartments based on a dual threshold technique for in vivo micro-CT bone analysis. Bone 41:505–515CrossRefPubMedGoogle Scholar
  9. Burnham JM, Kim DC, Kamineni S (2016) Midshaft clavicle fractures: a critical review. Orthopedics 39:e814–e821PubMedGoogle Scholar
  10. Daruwalla ZJ, Courtis P, Fitzpatrick C, Fitzpatrick D, Mullett H (2010) Anatomic variation of the clavicle: a novel three-dimensional study. Clin Anat 23:199–209PubMedGoogle Scholar
  11. Doube M, Klosowski MM, Arganda-Carreras I, Cordelieres FP, Dougherty RP, Jackson JS, Schmid B, Hutchinson JR, Shefelbine SJ (2010) BoneJ: free and extensible bone image analysis in ImageJ. Bone 47:1076–1079CrossRefPubMedPubMedCentralGoogle Scholar
  12. Gnudi S, Ripamonti C, Lisi L, Fini M, Giardino R, Giavaresi G (2002) Proximal femur geometry to detect and distinguish femoral neck fractures from trochanteric fractures in postmenopausal women. Osteoporos Int 13:69–73CrossRefPubMedGoogle Scholar
  13. Hunter DJ, Sambrook PN (2000) Bone loss. Epidemiology of bone loss. Arthritis Res 2:441–445CrossRefPubMedPubMedCentralGoogle Scholar
  14. Huttunen TT, Launonen AP, Berg HE, Lepola V, Fellander-Tsai L, Mattila VM (2016) Trends in the incidence of clavicle fractures and surgical repair in Sweden: 2001–2012. J Bone Joint Surg Am 98:1837–1842CrossRefPubMedGoogle Scholar
  15. Karlsson KM, Sernbo I, Obrant KJ, Redlund-Johnell I, Johnell O (1996) Femoral neck geometry and radiographic signs of osteoporosis as predictors of hip fracture. Bone 18:327–330CrossRefPubMedGoogle Scholar
  16. Keaveny TM, Morgan EF, Niebur GL, Yeh OC (2001) Biomechanics of trabecular bone. Annu Rev Biomed Eng 3:307–333CrossRefPubMedGoogle Scholar
  17. Khan LA, Bradnock TJ, Scott C, Robinson CM (2009) Fractures of the clavicle. J Bone Joint Surg Am 91:447–460CrossRefPubMedGoogle Scholar
  18. Kihlstrom C, Moller M, Lonn K, Wolf O (2017) Clavicle fractures: epidemiology, classification and treatment of 2422 fractures in the Swedish Fracture Register; an observational study. BMC Musculoskelet Disord 18:82CrossRefPubMedPubMedCentralGoogle Scholar
  19. Li Z, Kindig MW, Kerrigan JR, Kent RW, Crandall JR (2013) Development and validation of a subject-specific finite element model of a human clavicle. Comput Methods Biomech Biomed Engin 16:819–829CrossRefPubMedGoogle Scholar
  20. Marcus R (1996) Clinical review 76: the nature of osteoporosis. J Clin Endocrinol Metab 81:1–5PubMedGoogle Scholar
  21. Mathieu PA, Marcheix PS, Hummel V, Valleix D, Mabit C (2014) Anatomical study of the clavicle: endomedullary morphology. Surg Radiol Anat 36:11–15CrossRefPubMedGoogle Scholar
  22. Parfitt AM (1984) Age-related structural changes in trabecular and cortical bone: cellular mechanisms and biomechanical consequences. Calcif Tissue Int 36(Suppl 1):S123–S128CrossRefPubMedGoogle Scholar
  23. Postacchini F, Gumina S, De Santis P, Albo F (2002) Epidemiology of clavicle fractures. J Shoulder Elb Surg 11:452–456CrossRefGoogle Scholar
  24. Qiu XS, Wang XB, Zhang Y, Zhu YC, Guo X, Chen YX (2016) Anatomical study of the clavicles in a Chinese population. Biomed Res Int 2016:6219761PubMedPubMedCentralGoogle Scholar
  25. Robinson CM (1998) Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br 80:476–484CrossRefPubMedGoogle Scholar
  26. Schneider CA, Rasband WS, Eliceiri KW (2012) NIH Image to ImageJ: 25 years of image analysis. Nat Methods 9:671–675CrossRefPubMedPubMedCentralGoogle Scholar
  27. Schuit SC, van der Klift M, Weel AE, de Laet CE, Burger H, Seeman E, Hofman A, Uitterlinden AG, van Leeuwen JP, Pols HA (2004) Fracture incidence and association with bone mineral density in elderly men and women: the rotterdam study. Bone 34:195–202CrossRefPubMedGoogle Scholar
  28. Sebesta P, Hach J, Tlusty St Z (2014) Middle-third clavicle fracture with ipsilateral acromioclavicular dislocation. Acta Chir Orthop Traumatol Cech 81:238–240PubMedGoogle Scholar
  29. Singh M, Nagrath AR, Maini PS (1970) Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg Am 52:457–467CrossRefPubMedGoogle Scholar
  30. Stanley D, Trowbridge EA, Norris SH (1988) The mechanism of clavicular fracture. A clinical and biomechanical analysis. J Bone Joint Surg Br 70:461–464CrossRefPubMedGoogle Scholar
  31. Walters J, Solomons M, Roche S (2010) A morphometric study of the clavicle. SA Orthopedic J 9:47–52Google Scholar

Copyright information

© Japanese Association of Anatomists 2018

Authors and Affiliations

  1. 1.Department of AnatomyTokyo Medical UniversityTokyoJapan
  2. 2.Department of AnatomyInternational University of Health and Welfare School of MedicineNaritaJapan
  3. 3.Department of Orthopaedics, Trauma and Plastic SurgeryUniversity of LeipzigLeipzigGermany
  4. 4.Anatomy and Cell BiologyMartin Luther University, Halle-WittenbergHalle (Saale)Germany

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