European Journal of Cardiovascular Medicine

The clavicle, often referred to as the collarbone, plays a fundamental role in stabilizing the shoulder and facilitating upper limb movement. It is a unique bone due to its anatomical location and its interaction with surrounding structures. Nutrient foramina are small openings that allow blood vessels to penetrate bone tissue, providing essential nourishment. In long bones like the clavicle, these foramina are crucial for maintaining bone health, especially in the context of growth and repair [1].

Though previous studies have examined nutrient foramina in various bones, there is a notable lack of research regarding their distribution in the clavicle, particularly in the Indian population [2]. This study aims to fill that gap, focusing on the distribution, direction, and size of nutrient foramina in 102 clavicles. Previous research has demonstrated that nutrient foramina play a significant role in the vascular supply of bones, and any variation in their location or size could influence surgical outcomes [3]. It has also been established that the number and distribution of nutrient foramina can vary based on anatomical and genetic factors [4].

These insights will be valuable for both clinicians and surgeons, helping to improve the outcomes of procedures such as clavicular fracture fixation or other interventions involving the clavicle [5]. Previous studies have highlighted the importance of these foramina in orthopaedic surgeries, emphasizing the need for detailed anatomical knowledge to avoid complications [6].

Study Design:

This was a cross-sectional, observational study conducted over a one-year period (November 2023– November 2024) at Jalpaiguri Government Medical College. The study included a total of 102 clavicles.

Inclusion Criteria:

Clavicles which were included, those were free from any sign of fractures, pathologies.

Exclusion Criteria:

Clavicles that showed signs of fractures, deformities, or prior surgical interventions were excluded from the study.

Data Collection:

Nutrient foramina were identified based on their location, number, and direction. The characteristics assessed

included:

• Number of Foramina: The total count of nutrient foramina in each clavicle.

• Location: The position of the foramina was classified into three regions: medial third, middle third, and lateral third.

• Direction: The direction in which the foramina directed – towards the sternal or acromial end.

• Size: The size of the foramina was categorized as small, medium, or large based on visible

Additionally, digital imaging was used to verify the size and location of each foramen.

Statistical Analysis:

The data were processed using descriptive statistics, focusing on the number, size, and location of nutrient foramina.

The study examined 102 clavicles. The following findings were noted:

Table 1: Distribution of Nutrient Foramina in Clavicles

Table 2: Size of Nutrient Foramina in Clavicle

Table 3: Direction of Nutrient Foramina in Clavicle

Key Findings:

1. Number of Foramina: The maximum number of nutrient foramina are located in the middle third(52.85 percent), then the medial third (30.89%) ,and the lateral third exhibiting the least (16.26%).
2. Size of Foramina: Most nutrient foramina were small (56.9%), followed by medium-sized (30.9%), and a smaller percentage were large (12.2%).
3. Direction of Foramina: A greater number of foramina directed towards the acromial end (95.93%) compared to the sternal end (4.07%).

This study sheds light on the distribution of nutrient foramina in the clavicle and their relevance in clavicular anatomy in the Indian population. It was observed that most nutrient foramina were found in the middle third of the clavicle followed by medial third of clavicle, a result consistent with previous studies on long bones [7]. The middle third of clavicle is the region most prone to fracture and trauma and periosteal arterial supply in this region should be preserved in case of fracture or trauma otherwise bone grafting may be needed [8].

Interestingly, the lateral third of the clavicle showed less number of foramina, suggesting that this portion might receive less vascularization. This is in agreement with previous studies that have found a similar pattern in clavicles from different populations [9]. The directionality of the foramina towards the acromial end of the clavicle are due to the fact that the nutrient artery runs opposite to that of the growing end of long bone, as the sternal end of clavicle is the growing end [10].

The predominance of small-sized nutrient foramina might indicate that the clavicle, while crucial for shoulder movement, does not require a large number of blood vessels in every region to remain healthy. These findings are important for surgical procedures, as understanding the precise location of nutrient foramina can help prevent inadvertent damage to blood vessels during clavicular surgeries, such as fracture fixation or osteotomies [1].

This study offers valuable anatomical data regarding nutrient foramina in the clavicle, enhancing our understanding of its vascular anatomy. The most frequent locations for these foramina were the medial and middle thirds of the clavicle, emphasizing the role of vascular supply in these regions. Surgeons and radiologists can use these findings to inform clinical practice, ensuring safer surgical outcomes when working with the clavicle. Future studies involving populations with clavicular pathologies may help further refine our understanding of how nutrient foramina behave in altered bone conditions.

1.    Murlimanju, B. V., Prabhu, L. V., Pai, M. M., Yadav, A., Dhananjaya, K. V., & Prashanth, K. U. (2011). Neurovascular foramina of the human clavicle and their clinical significance. Surgical and Radiologic    Anatomy,    33(8), 679-682. doi: 10.1007/s00276-011-0805-y. Epub 2011 Mar
22. PMID: 21424726.
2.    Dakshayani, K., &Shivanal, U. (2021). Morphological study of nutrient foramen in adult human clavicles. Journal of Morphological Sciences.PDF
3.    Hussain, A., Khalid, J., & Rauf, A. (2018). Nutrient foramen: Study of nutrient foramen in dried human clavicle. The Professional Medical Journal.PDF
4.    Saha, P. K., Mondal, M., Sarkar, S., & Bhaumik, D. (2017). An osteological study of the nutrient foramina of human clavicle. International Journal of Biomedical and Advance Research.PDF
5.    Keche, H. A., Thute, P. P., &Fulmali, D. G. (2021). Morphometric study of nutrient foramina in dry human clavicles in Central India. Indian Journal of Anatomy.PDF
6.    Sinha, P., Mishra, S. R., Kumar, P., & Singh, S. (2015). Morphometric & topographic study of nutrient  foramen  in  human  clavicle  in India. ResearchGate.PDF
7.    Tanna, N. A., & Tanna, V. A. (2015). Anatomical variation in position, direction, and number of nutrient foramina in clavicles. Journal of Morphological Anatomy.PDF
8.    Puspalatham, Sharmadha K.L, Meenakshi P. Topographic Anatomy and morphology of clavicle: An osteological study. Journal of Evidence based Nmedicine and health care; Volume 2, Issue 6, Feb 9, 2015;PP-729-735.
9.    Rajput, A. S. (2024). Variations in the position, number, and orientation of nutrient foramina in adult human clavicles. International Journal of Life Sciences, Biotechnology and Pharma Research, 13(7), 235-237. DOI: 10.69605/ijlbpr_13.7.2024.42. Online ISSN: 2250-3137, Print ISSN: 2977-0122.
10.    Neeta V Kulkarni, clinical anatomy, 3rd edition, vol. 1, 2016, page no. 37.