Measurement of Clavicular Symmetry in Healthy Subjects Using Tomographic Database of Public Hospitals / Mensuração de simetria clavicular em indivíduos saudáveis utilizando-se de banco de dados tomográficos de hospitais públicos

Abstract Objective This study aimed to perform an imaging evaluation to prove the existence or not of symmetry between the clavicles of healthy subjects from Curitiba, Paraná, Brazil, and identify potential factors influencing the clavicular length. Method The study analyzed chest computed tomography (CT) scans of 211 patients with no clavicular fracture or malformations (100 women and 111 men). We measured the greatest clavicular diagonal on both sides, and the software automatically generated the maximum distance in millimeters. Relative and absolute frequencies described qualitative variables and mean values; quantitative variables used a 95% confidence interval. Value comparisons employed the student's t-test, and correlations determinations used Pearson's correlation coefficient. The significance level adopted was 5%. Results There was a significant difference between the clavicular length (right clavicle, 143.58 mm; left clavicle, 145.72 mm; p = 0.037), indicating asymmetry. On average, the left clavicle was 3.71 mm larger. Asymmetry was significant for both men and women (p < 0.001). The average difference was 4.13 mm for men and 3.23 mm for women. Seventy-three percent of the sample had < 5 mm of asymmetry, 23.7% had 5 to 10 mm, and 3.3% had > 10 mm of asymmetry. Conclusion The studied population did not present clavicular symmetry. On average, the left clavicle was longer than the right clavicle, with differences of 3.71 mm in the general sample, 3.23 mm in women, and 4.13 mm in men. The only significant factor was gender since men presented longer clavicles and higher differences than women.

Resumo Objetivo Realizar avaliação imagiológica com intuito de comprovar a existência ou não de simetria entre as clavículas de indivíduos saudáveis da cidade de Curitiba/PR, aliada à identificação de possíveis fatores de influência no comprimento clavicular. Método Foram analisadas tomografias computadorizadas de tórax de 211 pacientes sem fratura ou malformações na clavícula (100 mulheres e 111 homens). A maior diagonal clavicular foi medida em ambos os lados e o software gerou automaticamente a máxima distância em milímetros. Foram utilizadas frequências relativas e absolutas para descrever variáveis qualitativas e a média e intervalo de 95% de confiança para as quantitativas. As comparações foram feitas com o teste t de Student e correlações calculadas pelo coeficiente de correlação de Pearson. O nível de significância adotado foi de 5%. Resultados Verificou-se diferença significativa entre o comprimento das clavículas (direita 143.58mm e esquerda 145.72mm, p = 0.037), indicando assimetria. Em média, o lado esquerdo é 3.71mm maior. A assimetria foi significativa tanto para homens quanto para mulheres (p < 0.001). A diferença média foi de 4.13mm para homens e 3.23mm para mulheres. 73% da amostra apresentou <5mm de diferença, enquanto 23.7% apresentou 5-10mm e 3.3% apresentou >10mm de assimetria. Conclusão Não foi possível encontrar simetria nas clavículas da população de Curitiba/PR. Em média, a clavícula esquerda é maior que a direita, com diferenças de 3.71mm na amostra geral, 3.23mm para mulheres e 4.13mm para homens. O único fator significativo foi o sexo, com homens tendo maiores comprimentos claviculares e maiores diferenças em comparação às mulheres.

Sex determination using scapular and clavicular parameters in modern Thai population / Determinación del sexo utilizando parámetros escapulares y claviculares en la población tailandesa moderna

SUMMARY: As natural disasters or crimes, precise postmortem identification is needed especially in case of unknown human remains. The aim of the study is to assess sexual dimorphism by formulating new multivariate equations based on scapular and clavicular parameters for a modern Thai population. Eight left scapular and six left clavicular parameters were measured from 278 individuals (124 males and 124 females for training group; and 15 males and 15 females for test group) of a modern Thai population with age ranges from 19 to 101 years. All scapular and clavicular parameters were sexually dimorphic. Direct and stepwise multivariate discriminant function analysis was performed to generate models. Three direct multivariate discriminant functions showed accuracy rates from 91.1c to 92.3 % (cross-validated range from 90.3 % to 91.5 %). Similarly, three stepwise multivariate discriminant functions showed accuracy rates from 90.7 % to 92.7 % (cross-validated range from 90.7 % to 92.7 %). Moreover, the test group showed 86.67 % to 100 % of sex determination accuracy in six discriminant functions. As recommendation for sex determination by using combination of the scapular and clavicular parameters yields statistically high accuracy for sex determination. Therefore, the accuracies of these multivariate discriminant function equations obtained from scapula and clavicle can be applied for forensic sex determination, especially in modern Thais.

RESUMEN: En casos de desastres naturales o crímenes se requiere una identificación post mortem precisa, especialmente en el caso de restos humanos desconocidos. El objetivo de este estudio fue evaluar el dimorfismo sexual mediante nuevas ecuaciones multivariadas basadas en parámetros escapulares y claviculares para una población tailandesa moderna. Se midieron ocho parámetros escapulares izquierdos y seis claviculares izquierdos de 278 individuos (124 hombres y 124 mujeres para el grupo de entrenamiento; y 15 hombres y 15 mujeres para el grupo de prueba) de una población tailandesa moderna con rangos de edad de 19 a 101 años. Todos los parámetros escapulares y claviculares presentaban dimorfismo sexual. Se realizaron análisis de funciones discriminantes multivariadas directas paso a paso para generar modelos. Tres funciones discriminantes multivariadas directas mostraron tasas de precisión de 91,1 % a 92,3 % (rango de validación cruzada de 90,3 % a 91,5 %). De manera similar, tres funciones discriminantes multivariadas mostraron tasas de precisión de 90,7 % a 92,7 % (rango de validación cruzada de 90,7 % a 92,7 %). Además, el grupo de prueba mostró del 86,67 % al 100 % de precisión en la determinación del sexo en seis funciones discriminantes. Como recomendación para la determinación del sexo mediante el uso de la combinación de los parámetros escapulares y claviculares, se obtiene una precisión estadísticamente alta para la determinación del sexo. Por lo tanto, las precisiones de estas ecuaciones de funciones discriminantes multivariadas obtenidas de la escápula y la clavícula se pueden aplicar para la determinación forense del sexo, especialmente en los tailandeses modernos.

Clavicle in Carnivorans: A Forgotten Bone.

The clavicle is a bone whose development is related to the versatility of the thoracic limbs in mammals. Studies with vestigial structures are scarce and controversial, especially in the order Carnivora. The objective of this study was to verify the presence and to investigate the shape and constitution of the clavicle in neotropical carnivores. In order to do this, 108 cadavers of 19 different species were collected dead on highways and were analyzed. The clavicles were submitted to dissections, longitudinal length measurements, radiographs, histological sections and, in some cases, diaphanization. Sixteen of the 19 species had clavicles in both sides, being significantly larger (P < 0.05) and distinctly more radiopaque in the felids than in the other families. There were no macro or microscopic evidence of clavicle in the specimens of Nasua nasua (n = 6), Conepatus semistriatus (n = 2), and Conepatus chinga (n = 1). The clavicle of the males of Lycalopex gymnocercus, Galictis cuja, and Leopardus geoffroyi was significantly larger (P < 0.05). The predominating contour of the clavicles was a thin stick with cranial convexity. The histological sections demonstrated compact bone consisting of trabecula and lamellae filled by bone marrow and different levels of occupation by chondroid matrix. It can be proposed the clavicles of the order Carnivora, although vestigial and rarely absent, have their presence, constitution and shape more associated with the phylogenetic proximity and evolutionary history of the species than to the variety of movements the thoracic limbs perform in free-living conditions. Anat Rec, 2019. © 2019 American Association for Anatomy Anat Rec, 303:1831-1841, 2020. © 2019 American Association for Anatomy.

Fusion of the medial clavicular epiphysis in the South African and Kenyan populations / Fusión de la epífisis clavicular medial en las poblaciones de Sudáfrica y Kenia

Age estimation from clavicular ossification has been studied by many researchers based on the pattern and degree of the epiphyseal union through the use of dry bone specimens, radiographs, CT and MRI. These studies found clavicular ossification as a useful age indicator up to the third decade of life. The study aimed to document any population specific influence on age estimation using fusion processes of the clavicular epiphysis between the South African and Kenyan population groups. To achieve this objective a study of one thousand six hundred and five (n=1605) digital radiographs of South African and Kenyan population groups, aged between 14-30 years, were evaluated. The ossification process of the medial clavicular epiphysis was scored against Schmeling's staging system. Growth variations between the two cohorts were carried out using student t-test analysis to assess for any significant differences between the means and standard deviations of the cohorts. A log linear regression test was also applied to test bilateral asymmetry in the ossification status for the medial epiphysis. The results of the paired linear model indicated a wide gap between chronological age (CA) and estimated age (EA) in patients under 20 years. The regression tests observed no significant difference between the EA of the South African and Kenyan populations. The current study yielded no significant differences in the ossification process of the medial clavicle amongst the Black South African and Kenyan populations when using Schmeling's staging system.

La estimación de la edad a partir de la osificación clavicular ha sido estudiada por muchos investigadores según el patrón y el grado de unión epifisaria mediante el uso de muestras de hueso seco, radiografías, tomografía computarizada y resonancia magnética. Estos estudios encontraron la osificación clavicular como un indicador de edad útil hasta la tercera década de la vida. El estudio tuvo como objetivo documentar cualquier influencia específica de la población en la estimación de la edad utilizando los procesos de fusión de la epífisis clavicular entre los grupos de población de Sudáfrica y Kenia. Para lograr este objetivo, se evaluó un estudio de mil seiscientas cinco (n = 1605) radiografías digitales de grupos de la población de Sudáfrica y Kenia, con edades comprendidas entre 14 y 30 años. El proceso de osificación de la epífisis clavicular medial se puntuó frente al sistema de estadificación de Schmeling. Las variaciones de crecimiento entre las dos cohortes se llevaron a cabo utilizando la prueba t de Student para evaluar las diferencias significativas entre las medias y las desviaciones estándar de las cohortes. También se aplicó una prueba de regresión lineal para evaluar la asimetría bilateral en el estado de osificación de la epífisis medial. Los resultados del modelo lineal indicaron una gran brecha entre la edad cronológica (CA) y la edad estimada (EA) en pacientes menores de 20 años. En las pruebas de regresión no se observaron diferencias significativas entre la EA de las poblaciones de Sudáfrica y Kenia. El presente estudio no presentó diferencias significativas en el proceso de osificación epífisis medial de la clavícula entre las poblaciones negras de Sudáfrica y Kenia cuando se usó el sistema de estadificación de Schmeling et al.

Morphometry of Isan-Thai clavicles as a guide for sex determination / Morfometría de las clavículas en una población Isan-Thai como guía para la determinación del sexo

The dried clavicles have been well documented to determine individual sex and age in many races. Such morphometric investigations in Isan (Northeastern) Thais have never been reported. Therefore, this study aimed to estimate the sex from dried clavicles of Isan-Thais using morphometric analysis. The identified 454 dried clavicles (254 males and 200 females), averaged age (60.69±14.36 years) were measured and analyzed for identification point (IP) and the demarking point (DP) values. The results showed that the identified-bone percentages by IP of the maximum clavicular lengths in males and females were 90.55 % (>139.9 mm) and 89 % (<140.6 mm). In addition, such percentages of the mid shaft circumference measured in male clavicles was 83.46 % (>37.7 mm) and in females was 75 % (<37.0 mm). However, percentages of the DP in all parameters were less than 50%. The highest DP values of maximum length of male clavicles was 43.31% (>152.5). In conclusion, the maximum length and mid shaft circumference investigated from this study can be used as basic data of Isan ­ Thais for applying as a guide in forensic sciences for sex determination from dried clavicle remains.

Las clavículas secas han sido bien documentadas en muchas razas para determinar el sexo y la edad individuales. Tales investigaciones morfométricas en Isan (Noreste de Tailandia) nunca han sido reportadas. Por lo tanto, este estudio tuvo como objetivo estimar el sexo de clavículas secas de Isais-Thais utilizando un análisis morfométrico. Se midieron 454 clavículas secas (254 varones y 200 hembras), con una edad media de 60,69 ± 14,36 años, y fueron analizadas para los puntos de identificación (IP) y de demarcación (DP). Los resultados mostraron que los porcentajes de hueso identificados por IP en relación a la longitud clavicular máxima en hombres y mujeres fueron 90,55 % (> 139,9 mm) y 89 % (<140,6 mm), respectivamente. Además, tales porcentajes de circunferencia media del eje, medido en las clavículas de los hombres, fue 83,46 % (> 37,7 mm) y en las de mujeres fue 75 % (<37,0 mm). Sin embargo, los porcentajes de la DP en todos los parámetros fueron menores al 50 %. Los valores más altos de DP de longitud máxima de las clavículas de los hombres fue 43,31 % (> 152,5). En conclusión, la longitud máxima y la circunferencia media del eje investigados a partir de este estudio se pueden utilizar como datos básicos en Isan - Thais para aplicar como guía en las ciencias forenses para la determinación del sexo a partir de restos de clavícula secas.

Tubérculo deltoideo: discrepancias entre la terminología anatómica y bibliografía anatómica / Deltoid tubercle: discrepancies between the anatomical terminology and anatomical bibliography

Uno de los criterios establecidos por el Comité Federativo Internacional en Terminología Anatómica pretende evitar la redundancia terminológica y aunque se realizan simposios ibero-latinoamericanos de terminología, la unificación de criterios terminológicos en la práctica no se ha conseguido satisfactoriamente; la lectura de algunos libros e incluso artículos científicos del área lo demuestra. Se realizó una revisión bibliográfica para evaluar si existen discrepancias entre la terminología anatómica y bibliografía anatómica con respecto al uso del término "tubérculo deltoideo" (A02.4.01.006) asociado a la espina de la escápula. Se revisaron 53 textos de Anatomía, creando fichas anatómicas de descripciones tanto de la escápula como la clavícula, a partir de libros con texto y/o imágenes. Luego se establecieron criterios de clasificación y se construyeron listas de cotejo con el fin de tabular las descripciones bibliográficas. De los textos anatómicos revisados y consultados: el 15 % menciona en la descripción el "tubérculo deltoideo" asociado a la escápula, mientras que un 28 % asocia el "tubérculo deltoideo" a la clavícula. Se puede concluir que el término se asocia en la bibliografía a ambos huesos, discrepando con la Terminología Anatómica Internacional. Se propone una revisión del término "tubérculo deltoideo" asociado a la espina de la escápula, dadas las discrepancias entre la terminología y la bibliografía anatómica, Este trabajo es parte de una primera etapa en la búsqueda más exhaustiva de un término más adecuado para el lugar de inserción del músculo deltoides en la clavícula.

One of the criteria established by the Federative International Committee for Anatomical Terminology is the attempt to avoid redundancy in terminology and although Ibero-Latin American symposiums of terminology have been carried out to those ends, in practice the unification of terminology criteria has not been satisfactorily achieved. This can readily be observed in the existing literature, books and scientific articles related to this particular area. A bibliographic review aimed at evaluating whether there are discrepancies between the anatomical terminology and anatomic bibliography regarding use of the term "deltoid tubercle" (A02.4.01.006) associated to the scapular spine was prepared. Fifty-three anatomy texts were reviewed, summary sheets, based on books, with wording and/or pictures, describing the anatomy of the scapula and the clavicle were created. Subsequently, the classification criteria was determined and checklists with the purpose of tabulating the bibliographic descriptions were prepared. From the anatomical texts reviewed and studied: 15 % mention in the description the "deltoid tubercle" associated to the scapula, whereas 28 % associates the "deltoid tubercle" to the clavicle. From this we can conclude that in the bibliography this term is associated to both bones, in disagreement with the International anatomical terminology. Given the discrepancies between the terminology and the anatomical bibliography, the revision of the concept "deltoid tubercle" associated to the spine of the scapula is proposed. This paper is part of the first stage of a more accurate search of a more adequate term for the place where the deltoid muscle inserts in the clavicle.

Sex determination using morphometric and morphological dimensions of the clavicle within the KwaZulu-natal population / Determinación de sexo dentro de la población KwaZulu-natal mediante el uso de dimensiones morfométricas y morfológicas de la clavícula

Sex determination plays an essential role in forensic anthropology in the identification of an individual from skeletal remains. The aim of the study was to determine sex of an individual using the clavicle in a KwaZulu-Natal population. Various morphometric and morphological parameters were measured using 100 clavicles of known sex (66 male and 34 female) and age (range 25­95 years). The mean maximum length, mid-shaft circumference and maximum breadth of the sternal and acromial ends of the male clavicles were greater in females. However, the mean medial curve of the clavicle was greater in females than in males on both sides, and on the right side the female clavicles also had a greater mean lateral curve than the males. The maximum length and mid-shaft circumference alone could be used to predict sex with an accuracy of 89 %. Therefore, the provision of morphometric data pertaining to the clavicle may assist forensic investigators, anthropologists and anatomists to sex the clavicle.

La determinación del sexo juega un papel esencial en la antropología forense e identificación de un individuo con restos óseos. El objetivo fue determinar el sexo de un individuo mediante la clavícula en una población KwaZulu-Natal. Se midieron varios parámetros morfométricos y morfológicos utilizando 100 clavículas (66 hombres y 34 mujeres) con un rango etario entre 25­95 años. La longitud máxima media, circunferencia media del eje y la amplitud máxima de los extremos esternal y acromial de las clavículas de los hombres fueron mayores que en las mujeres. Sin embargo, la curva medial media de la clavícula fue mayor en mujeres que en hombres en ambos lados, y en el lado derecho las mujeres también tenían una curva lateral media de las clavículas mayor que en los hombres. La circunferencia máxima y la circunferencia media del eje por sí solas podrían ser utilizadas para predecir el sexo con una precisión de 89 %. Por tanto, la información de datos morfométricos relativos a la clavícula pueden ayudar a los investigadores forenses, antropólogos y anatomistas en la determinación del sexo.

Age estimation from ossification of the medial clavicular epiphysis by computed tomography / Estimación de la edad de osificación de la epífisis medial clavicular por tomografía computadorizada

The current study intended to evaluate the accuracy of age estimation from the development of the medial clavicular epiphysis (sternal end of the clavicle) in Egyptian population using computed tomography (CT) and to develop a discriminant formula that can be used in Egyptians. The study was conducted on 142 subjects (84 males and 58 females) after taken informed consent. They were subjected to multi-slice CT on the medial end of clavicles of both sides. The results revealed that the age of non - union was seen at 8­17 years; incomplete union at 15­20 years and complete union was seen at 20 years. It is concluded that the ossification of medial clavicular end could be used for age estimation. Also CT is a good visualization tool to be used. Regression analysis for each and both clavicles in both sexes is specific to Egyptian population and should be used after validation of the results in other ones. The study recommended using stage 1 to be <17 years; stage 2 to be >15 years; Stage 3 to be >15 years; stage 4 of maturation to be >19 years and stage 5 to be >21 years.

El objetivo de esta investigación fue evaluar en la población egipcia, la exactitud de estimación de edad del desarrollo de la extremidad esternal de la clavícula, mediante tomografía computadorizada (TC), y desarrollar una fórmula discriminante que se pueda utilizar en egipcios. La investigación se realizó en 142 pacientes (84 hombres y 58 mujeres) después de obtener el consentimiento informado. Los pacientes fueron sometidos a TC de cortes múltiples en la extremidad esternal de la clavícula en ambos lados. Los resultados revelaron que la no unión fue observada entre los 8­17 años; la unión incompleta entre 15­20 años y la unión completa a los 20 años. Se concluye que la osificación de la extremidad esternal de la clavícula podría ser utilizada para la estimación de la edad utilizando la TC como herramienta de visualización. El análisis de regresión para ambas clavículas en los dos sexos es específico de la población egipcia y se debe utilizar después de validar los resultados. El estudio recomienda el uso de la etapa 1 en <17 años, etapa 2 en >15 años, etapa 3 en >15 años, etapa 4 en la maduración >19 años y la etapa 5 >21 años.

Zona de segurança no acesso cirúrgico do terço médio da clavícula: estudo em cadáveres / Safety zone for surgical access in the middle third of the clavicle: study on cadavers

OBJETIVO:Estabelecer uma zona de segurança neurovascular no acesso cirúrgico do terço médio da clavícula por dissecção em cadáveres.MÉTODOS:Foram dissecados 20 ombros de 10 cadáveres, foi feita a dissecção profunda do terço médio da clavícula e identificaram-se as seguintes estruturas: veia subclávia, tronco superior do plexo braquial (divisão anterior e posterior) e nervo supraescapular. Essas estruturas foram demarcadas para mensuração de suas distâncias até os pontos mais próximos do terço médio da clavícula.RESULTADOS:A distância média do terço médio da clavícula ao nervo supraescapular, à veia subclávia, ao tronco superior, à divisão anterior do tronco superior e à divisão posterior do tronco superior foi, respectivamente, do lado direito: 15,92 cm; 10,77 cm; 23,68 cm; 14,60 cm e 15,42 cm; do lado esquerdo: 12,69 cm; 9,82 cm; 22,19 cm; 12,16 cm e 13,46 cm.CONCLUSÃO:Houve diferença estatística entre as distâncias do nervo supraescapular e a divisão anterior do tronco superior comparativa entre os lados direito e esquerdo. As estruturas neurovasculares mais próximas ao terço médio da clavícula foram o nervo supraescapular e a veia subclávia.

OBJECTIVE: The aim of this study was to establish a neurovascular safety zone for surgical access in the middle third of the clavicle, by means of dissection on cadavers. METHODS: Twenty shoulders were dissected in 10 cadavers, with deep dissection of the middle third of the clavicle. The following structures were identified: subclavian vein, upper trunk of the brachial plexus (anterior and posterior divisions) and suprascapular nerve. These structures were marked out in order to measure their distances from the most proximal point of the middle third of the clavicle. RESULTS: The mean distances from the middle third of the clavicle to the suprascapular nerve, subclavian vein, upper trunk, anterior division of the upper trunk and posterior division of the upper trunk were respectively, for the right side: 15.92 cm, 10.77 cm, 23.68 cm, 14.60 cm and 15.42 cm; and for the left side: 12.69 cm; 9.82 cm; 22.19 cm; 12.16 cm and 13.46 cm. CONCLUSION: There was a statistical difference in the distances to the suprascapular nerve and anterior division of the upper trunk, in comparing between the right and left sides. The closest neurovascular structures to the middle third of the clavicle were the suprascapular nerve and subclavian vein.

[Ultrasound-guided continuous infraclavicular block for hand surgery: technical report arm position for perineural catheter placement]. / Bloqueo infraclavicular continuo guiado por ultrasonido para cirugía de mano. Reporte técnico de la posición del brazo para la colocación del catéter perineural.

BACKGROUND: Continuous perineural infusion of local anesthetic provides better postoperative analgesia than intravenous administration of opioids or NSAIDs in upper limb surgery. The infraclavicular approach is a good option due to the muscular stability to catheter; the abduction of the arm apparently makes more superficial the brachial plexus and which elevates clavicle cephalad. AIM: The aim of this study was to identify whether the abduction of the arm for to decreases the skin-plexus distance, facilitating it catheter insertion in a perineural way for a better analgesia. This relation between the arm and the colocation of catheter has not yet been established. MATERIAL AND METHODS: We included 58 adult patients, undergoing forearm and hand surgery, initially divided into two groups, adduction and abduction. It was placed continuous infraclavicular block guided by ultrasound, it allow the catheter tip was adjacent to the posterior cord. In the group patients with high technical difficulties were allowed to reposition the arm abduction, recording number of punctures, redirects, ease of insertion of the catheter and skin-plexus distance. RESULTS: The abduction of the arm moved the clavicle toward cephalad and separated it from the linear transducer, this allowed to maneuver the needle right angle and redirect it, the distance skin-plexus did not decrease significantly with arm position. CONCLUSIONS: Arm abduction allows better scanning facilitates the infraclavicular puncture and catheter introduction.

Geometric morphometric analysis of the breast-shoulder apparatus of lizards: a test case using Jamaican anoles (Squamata: Dactyloidae).

The breast-shoulder apparatus (BSA) is a structurally and kinematically complex region of lizards. Compared with the pelvic region it has received little attention, even though its morphological variation is known to be extensive. This variability has seldom been the focus of functional explanation, possibly because the BSA has been difficult to explore as a composite entity. In this study we apply geometric morphometric techniques to the analysis of the BSA in an attempt to more fully understand its configuration in relation to differential use in locomotion. Our approach centers upon the Jamaican radiation of anoline lizards (genus Norops) as a tractable, small monophyletic assemblage consisting of species representing several ecomorphs. We hypothesized that the different species and ecomorphs would exhibit variation in the configuration of the BSA. Our findings indicate that this is so, and is expressed in the component parts of the BSA, although it is subtle except for Norops valencienni (twig ecomorph), which differs greatly in morphology (and behavior) from its island congeners. We further found similarities in the BSA of N. grahami, N. opalinus (both trunk-crown ecomorphs), and N. garmani (crown giant). These outcomes are promising for associating morphology with ecomorphological specialization and for furthering our understanding of the adaptive response of the BSA to demands on the locomotor system.

Study on the time frame for ossification of the medial clavicular epiphyseal cartilage by x-ray in ghanaian students / Estudio con rayos x sobre el periodo de tiempo para la osificación del cartílago epifisial clavicular medial en estudiantes ghaneses

The objective of this study was to determine the rate of ossification of the medial epiphysis of the clavicle and some of the different factors that may influence the rate of ossification in the Ghanaian population. The study was a retrospective study and was conducted at the University of Cape Coast hospital, Cape Coast, Ghana. Chest x-rays of 1035 first year University of Cape Coast students admitted, for the 2008/2009 academic year were used. Statistically significant differences were produced for some of the stages when sex comparisons were done using the t-test for two independent groups with a 95 percent confidence level. Stages 2 (p=0.001), stage 3 (p<0.001) and stage 4 (p=0-001). The age of onset of ossification of the medial clavicle appeared generally to be earlier in females than in males. The stage of partial ossification of the medial clavicular epiphysis also lasted longer than in other studies indicating a delay in the ossification at this stage. In conclusion conventional x-ray of the medial clavicle can be an effective tool in assessing forensic age of subjects for any purpose; however there is a need to develop reference values that are specific for particular geographical areas.

El objetivo de este estudio fue determinar la tasa de osificación de la extremidad esternal de la clavícula y determinar algunos de los diferentes factores que pueden influir en la tasa de osificación en la población de Ghana. Se efectuó un estudio retrospectivo en el hospital de la Universidad de Cape Coast, Cape Coast, Ghana. Se utilizaron 1035 radiografías de tórax de estudiantes admitidos al primer año de la Universidad de Cape Coast, el año académico 2008/2009. Se observaron diferencias estadísticamente significativas para algunas de las etapas en que se realizan comparaciones de sexo mediante el t-test para dos grupos independientes con un nivel de confianza del 95 por ciento. Etapas 2 (p = 0,001), la etapa 3 (p <0,001) y la etapa 4 (p = 0-001). La edad de inicio de la osificación de la extremidad esternal de la clavícula aparecía generalmente antes en las mujeres que en los hombres. La etapa de osificación parcial de las extremidad esternal de la clavícula también duró más tiempo que lo relatado en otros estudios los cuales indican un retraso en la osificación en esta etapa. En conclusión la radiografía convencional de la extremidad esternal de la clavícula puede ser una herramienta eficaz en la evaluación forense de la edad de los sujetos, sin embargo existe necesidad de definir valores de referencia que sean específicos para determinadas zonas geográficas.

Radiologic evaluation of clavicular morphology in southern Nigerians / Evaluación radiólogica de la morfología clavicular en nigerianos del sur

This study was carried out to derive empirical values and indices for which clavicles on a radiograph can be correctly sexed. 1000 radiographic left clavicles of adults of both sexes (500 males and 500 females) ranging from ages 25 ­ 60 yrs collated from the Radiology departments of University of Port Harcourt Teaching Hospital, University of Calabar Teaching Hospital and The General Hospital Calabar, all in Southern Nigeria, were used in this study. The values obtained in this study showed that, the males had Sternal head length of 2.52±0.33 cm, Acromial head length of 1.66±0.25 cm, a mid shaft diameter of 2.01 cm and body length of 15.28±0.66 cm. The female Sternal head length was 2.18±0.37 cm, Acromial head length was 1.65±0.22 cm, mid shaft diameter was 1.48 cm and the mean body length was 14.56±0.51 cm. The sternal head of the males was significantly longer than the females (P<0.001) but the body and acromial head lengths were not. The length / mid shaft diameter ratio and the product of the length and mid shaft diameter were also derived. The use of the demarking point analysis to identify sex showed very low percentages in all the parameters studied.

Este estudio fue realizado para obtener los valores empíricos e índices para que clavículas puedan ser correctamente sexuadas radiográficamente. Fueron utilizadas 1000 radiografías de clavículas del lado izquierdo de individuos adultos (entre 25 y 60 años de edad) de ambos sexos (500 hombres y 500 mujeres), recolecadas por los departamentos de radiología de la Universidad Port Harcourt Teaching Hospital, Universidad Calabar Teaching Hospital y Hospital General de Calabar, todos ellos del sur de Nigeria. Los valores obtenidos mostraron que los hombres tenían una longitud de la extremidad esternal de 2,52±0,33 cm, y de la extremidad acromial de 1,66±0,25 cm, un diámetro del eje medio de 2,01cm y una longitud del cuerpo de 15,28±0,66 cm. En las mujeres, la longitud a extremidad esternal fue de 2,18±0,37 cm, de la extremidad acromial de 1,65±0,22 cm, un diámetro del eje medio de 1,48 cm y una longitud del cuerpo promedio de 14,56±0,51 cm. La extremidad esternal de los hombres era significativamente más larga que en mujeres (p<0,001), pero no la longitud del cuerpo y la extremidad acromial. Fueron obtenidas la relación longitud/diámetro del eje medio y el producto de la longitud y diámetro del eje medio. El uso del análisis del punto de demarcación para diferenciar el sexo presentó porcentajes muy bajos en todos los parámetros estudiados.

Coracoclavicular and costoclavicular joints at a common juncture: a rare phenomenon / Articulaciones coracoclavicular y costoclavicular en una unión común: un raro fenómeno

Movements at the human shoulder girdle are the result of complex interplay of glenohumeral, acromioclavicular, sternoclavicular and scapulothoracic articulations. Clavicle apart from articulating with the scapula and sternum is also connected with first rib by costoclavicular ligament and with coracoid process by coracoclavicular ligament. At times the area of attachment of these ligaments on clavicle, first rib and scapula show faceted apophysis suggesting the presence of additional diarthrodial articulations. Costoclavicular joint exists between clavicle and first rib and coracoclavicular joint between clavicle and coracoids process. Both these joints are described in the literature, but the concurrent occurrence of them in the same bone has not been reported yet. We found two clavicles, one of right and other of left side, both of them showed faceted apophysis for costoclavicular and coracoclavicular joint simultaneously, which is rare phenomenon.

Los movimientos de la cintura escapular humana son el resultado de la interacción compleja de las articulaciones glenohumeral, acromioclavicular, esternoclavicular y escapulotorácica. La clavícula, aparte de la articulación con la escápula y el esternón también está conectada con la primera costilla por el ligamento costoclavicular y con el proceso coracoides por el ligamento coracoclavicular. A veces la zona de unión de estos ligamentos de la clavícula, la primera costilla y la escápula muestran procesos facetarios que sugieren la presencia de nuevas articulaciones diartrodiales. La articulación costoclavicular existe entre la primera costilla y la clavícula y la articulación coracoclavicular entre la clavícula y proceso coracoides. Ambas articulaciones están descritas en la literatura, pero la aparición simultánea de ellas en el mismo hueso no se ha informado aún. Se encontraron dos clavículas, uno del lado derecho y otra del lado izquierdo, las dos presentaron procesos facetarios para las articulaciones costoclavicular y coracoclavicular simultáneamente, lo cual es un fenómeno raro.

A rare muscle anomaly: the supraclavicularis proprius muscle.

In the Dissection Team of the Second Chair of Anatomy at the School of Medicine of the University of Buenos Aires, Argentina, during the routine dissection of 78 cadavers (corresponding to 156 supraclavicular fossae),10% formalin fixed, we found the supraclavicularis proprius muscle over the lower part of the left supraclavicular fossa in an adult Caucasian male cadaver. We described this rare muscular anomaly, the likelihood of finding this muscle, and its participation in supraclavicular nerve entrapment syndrome.

Incidence of clavicular rhomboid fossa (impression for costoclavicular ligament) in the Brazilian population: forensic application.

In the last years, anthropology has been widely explored mainly when related to bones due to its morphologic characteristics, such as the rhomboid fossa of the clavicle. This study examined the incidence of the rhomboid fossa in paired clavicles of Brazilian subjects obtained from 209 adult bodies of known age and sex (107 males and 102 females) on which postmortem examinations had been performed by the senior author. The data were submitted to qualitative statistical analysis according to Fisher. There was a statistical difference (p= 5.98 x 10-23) between sexes related to the frequency of the rhomboid fossa. The fossa was absent in 97,1% of the female clavicles and the incidence of bilateral fossa was present in 2,9% of females. The incidence of bilateral fossa was 29% for male clavicles. The sexual or side differences in the incidence of the fossa could be found in this study, and qualitative analysis can corroborate sex determination of unidentified bodies in forensic medicine.

Thoracic skeletal morphology and high-altitude hypoxia in Andean prehistory.

Living humans from the highland Andes exhibit antero-posteriorly and medio-laterally enlarged chests in response to high-altitude hypoxia. This study hypothesizes that morphological responses to high-altitude hypoxia should also be evident in pre-Contact Andean groups. Thoracic skeletal morphology in four groups of human skeletons (N = 347) are compared: two groups from coastal regions (Ancón, Peru, n = 79 and Arica, Chile, n = 123) and two groups from high altitudes (San Pedro de Atacama, Chile, n = 102 and Machu Picchu and Cuzco, Peru, n = 43). Osteometric variables that represent proportions of chest width and depth include sternal and clavicular lengths and breadths and rib length, curvature, and area. Each variable was measured relative to body size, transformed into logarithmic indices, and compared across sex-specific groups using ANOVA and Tukey multiple comparison tests. Atacama highlanders have the largest sternal and clavicular proportions and ribs with the greatest area and least amount of curvature, features that suggest an antero-posteriorly deep and mediolaterally wide thoracic skeleton. Ancón lowlanders exhibit proportions indicating narrower and shallower chests. Machu Picchu and Cuzco males cluster with the other highland group in rib curvature and area at the superior levels of the thorax, whereas chest proportions in Machu Picchu and Cuzco females resemble those of lowlanders. The variation in Machu Picchu and Cuzco males and females is interpreted as the result of population migrations. The presence of morphological traits indicative of enlarged chests in some highland individuals suggests that high-altitude hypoxia was an environmental stressor shaping the biology of highland Andean groups during the pre-Contact period.

Bases anatômicas para a ressecção da extremidade esternal da clavícula: estudo em cadáver / Anatomical fundaments to resect the sternal end of the clavicle: a study using cadavers

Objetivo: Realizar, em cadáver, estudo anatômico da margem de segurança para a ressecção da extremidade esternal da clavícula, identificando, em relação ao ligamento costoclavicular, a extensão do segmento ósseo clavicular, que pode ser ressecado sem causar instabilidade da articulação esternoclavicular. Métodos: Foram dissecados 100 ombros de 50 cadáveres frescos, todos do sexo masculino, com idade variando entre 17 e 65 anos, com média de 37 anos. Utilizando um paquímetro com precisão de 0,05cm, foi medida a distância entre a borda inferior do segmento clavicular da articulação esternoclavicular e a inserção mais medial, na clavícula, do ligamento costoclavicular. Resultados: A distância entre a borda inferior do segmento clavicular da articulação esternoclavicular e a inserção mais medial do ligamento costoclavicular variou entre 0,00 e 2,40cm, com média de 1,26cm. Em 3% dos ombros dissecados foi observado o ligamento costoclavicular estendendo-se até a borda inferior do segmento clavicular da articulação esternoclavicular, sem espaço ósseo livre em direção medial. Conclusões: A porção da clavícula proximal que pode ser ressecada sem lesar o ligamento costoclavicular, em cadáveres do sexo masculino, mede em média 1,26cm. O ligamento costoclavicular pode estender-se até a borda inferior do segmento clavicular da articulação esternoclavicular; por isso, torna-se importante a identificação desse ligamento nos procedimentos que envolvem ressecção da extremidade esternal da clavícula.

Resection of the medial end of the clavicle: an anatomic study.

The biomechanical importance of the costoclavicular ligament is well known; however, an extensive debate still exists regarding the amount of the medial clavicle that can be removed without injuring the ligament. The goal of this anatomic study in fresh cadavers is to measure the distance between the inferior articular surface of the medial clavicle and the most medial clavicular insertion of the costoclavicular ligament, as well as to verify whether there is a relationship between this measurement and the length of the clavicle. Dissection of 100 shoulders from 50 fresh cadavers was performed. All specimens were from male cadavers ranging in age from 17 to 65 years (mean, 37 years). Variation in clavicular length did not alter the distance between the inferior articular surface of the medial clavicle and the most medial clavicular insertion of the costoclavicular ligament, which in our study measured 1.26 cm. The costoclavicular ligament can extend as far as the inferior articular surface of the medial clavicle. We recommend identification of this ligament during surgeries for resection of the clavicle's proximal extremity.