Supraclavicular Nerves: Is There a “Safe Zone” for Surgical Fixation of the Clavicle? A Cadaveric Study

Objectives The supraclavicular nerve (SCN) supplies the skin over the clavicle and proximal chest. The unpredictable branching pattern of the SCN within the posterior triangle of the neck makes it susceptible to damage during open fixation of clavicle fractures. Resultant iatrogenic injuries can lead to paraesthesia and neuroma over the clavicle. The position of the SCN branches in relation to clinically appreciable landmarks has not hitherto been described. The aim of this study was to identify the precise location of the SCN branches in relation to the acromioclavicular (AC) and sternoclavicular (SC) joints. Methods Ten soft-embalmed cadavers, donated under the Human Tissue Act (2004), were carefully dissected along the superior border of both clavicles to identify the SCN branches. The distance from each branch of the SCN to the SC and AC joints was measured. Results The SCN was found to comprise either 2 branches (8/20), or 3 branches (12/20). No branches were found within 2.6 cm and 2.9 cm of the SC and AC joint, respectively. Between these two “safe zones”, the locations of the branches varied significantly. Conclusions No safe zone was identified in the mid-clavicular region. Hence, meticulous dissection is required here to preserve the SCN branches.