The clavicle is the only long bone oriented horizontally in the body, serving as the strut that connects the shoulder girdle to the axial skeleton at the sternoclavicular joint medially and the acromioclavicular joint laterally. It is the most commonly fractured bone.
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| Landmarks |
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| Ossification | First bone to begin ossifying (week 5 fetal) and last to complete (medial epiphysis fuses at age 25). Both endochondral and membranous ossification. |
The most commonly fractured bone in children and one of the most common in adults, with middle-third fractures at the S-curve junction occurring in over 80 percent. The subclavian vein posterior to the medial clavicle is accessed for central venous catheterisation with pneumothorax risk. Neurovascular injury from displaced fractures includes subclavian vessel and brachial plexus injury. Most fractures heal conservatively with a sling; surgical plating reduces non-union and improves outcomes in displaced mid-shaft fractures.
Start at the jugular notch and move sideways onto the rounded inner end of the clavicle at the sternoclavicular joint. Trace the bone outward along its full length, noticing that it curves forward in its inner two thirds and backward in its outer third, until you reach the small step of the acromioclavicular joint at the tip of the shoulder. The whole bone lies just under the skin.
One of the most common fractures, usually in the middle third from a fall onto the shoulder; most heal in a sling, though displaced or shortened fractures may need fixation.
Repetitive loading, classically heavy bench pressing, causes resorption of the lateral end of the clavicle and pain at the acromioclavicular joint.
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