JPAFMAT 2009; 9(1).

ISSN 0972-5687

A RARE ANOMALY OF THE CLAVICLE – BIFURCATION OF THE LATERAL ONE-

THIRD

Dr. Vijay P. Khanagwal, Professor

Dr. Luv Sharma, Professor
Dr. B.L. Sirohiwal, Professor
Dr. P.K. Paliwal, Senior Professor
Dr. R. K. Yadav#, Senior Professor
Dr. D.R. Yadav, Professor
Dr. Sudha Chhabra*, Senior Professor
Departments of Forensic Medicine, Radio-Diagnosis# and Anatomy*,
Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak.

Abstract
Gross and roentgenological examination of the human clavicles during 35 years of experience
revealed a rare anomaly of bifurcation of the lateral one-third, which can be of medical significance in
general and great medico-legal importance in identification of body. Its location and possible derivation
are discussed.
Keywords: Clavicle; Bifurcation; Anomaly

Introduction 18-20 years but this epiphysis is always small

and rapidly joins the shaft [5].

The clavicle or collar bone extends Case Report

almost horizontally with a double curve across
the root of the neck laterally towards the points
of the shoulder. It consists of cancellous bone
internally and enveloped by a layer of compact
bone which is much thicker in the intermediate
part than at ends [1]. Unlike most other long
bones it does not possess a medullary cavity [2-
3].
The clavicle is the first bone to start
ossifying and its epiphysis is last to appear.
During the seventh week of intrauterine fetal
age, two centers of chondrification appear in
these foci and two ossific centers soon unite.
From this double center, ossification spreads
towards sternum being preceded by formation
of cartilage. At the eighteenth year, a
secondary center appears in cartilage at the
sternal end of the bone. This epiphysis unites at
the age of 25-30 years [4]. A secondary center
at the acromian sometimes develops at about
In the present case, during autopsy on
the body of a 45 years old female, the shaft of
the left clavicle was found to be bifurcated in its
lateral one-third. Besides the normal lateral
one-third concave forward process, there was
an additional (extra) part of the bone
originating near the junction of the medial two-
third and lateral one-third. This extra process
extended antero-laterally towards the acromio-
clavicular joint, being at an angle of 30 degrees
with the normal lateral one-third of the shaft of
the clavicle. The bone weighed 35 grams and
the distance between the sternal and acromial
end was 12 cms whereas the distance between
the sternal end and the end of the extra process
(other than the normal lateral one-third of the
shaft of the bone) was 13 cms. The bone was
subcutaneous along its entire length. The ends
of the bifurcated lateral one-third of the shaft
of the clavicle were articulating with the

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corresponding scapula at the acromio-clavicular
joint. These two ends were 7.0 mm apart from
each other. The length of the normal lateral
one-third of the shaft was 3.5 cm whereas the
length of the other process was 4.0 cm and the
circumference of these two processes were 5
and 4.5 cm respectively.
Fig.1: Photograph of the clavicle
The corresponding scapula as well as
contra lateral clavicle and scapula were normal.
The photographs and x-rays of the specimen
were taken to observe the periosteum and
cortex of the bone to see the cortical continuity
of the bifurcated lateral one-third with the
medial two-third of the bone (Fig.1-2). The x-
rays of the bone confirm the continuity of the
medial two-third with the bifurcated lateral
one-third.
Fig.2: X-ray of the clavicle
Discussion
JPAFMAT 2009; 9(1). ISSN 0972-5687
Developmentally the clavicle may be
subjected to many variations [3], viz.
cleidocranial dystosis [6], congenital
pseudarthrosis, supernumerary clavicle [7], and
even the absence of outer one-third, the inner
two-third or the complete bone. Occasionally, a
projection from the clavicle forms and
articulates with the coracoids process of the
scapula; this has been called coraco-clavicular
joint [8]. A rare variation in form of facet on the
conoid tubercle, for articulation with the
coracoid process has also been reported [9].
Anomalous bifurcation of the lateral
one-third of the shaft of clavicle as was
observed in the present case has been reported
in a very few cases before. Various accounts in
the literature are described as supernumerary
bone [7], congenital anomaly [10], an anatomic
variant [11], developmental variant or an
acquired lesion [12]. Ogden described a
traumatic etiology and stated that it was likely
that the early reports occurred as the result of
unrecognized injuries [13] and the fracture of
lateral third of clavicle may lead to formation of
highly osteogenic periosteal tube and the distal
clavicle may become Y-shaped or bifid [14].
It is, therefore, a rare anomaly, the
cause of which is not exactly known. To the
best of our knowledge, this is the first Indian
report to document this anomaly of clavicle
with radiograph of the bone. Patients and
doctors should be observant of the possible
development of this rare variant of clavicle.
References
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