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
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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.
KeywordsCancellous 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).
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.
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Conflicts of interest
The authors declare that they have no conflict of interest.
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