A rare anatomical variant: transosseous supraclavicular nerve identified during clavicle fracture fixation

We describe a rare case of an anatomical variant of the supraclavicular nerve in the intra-operative setting of clavicle fixation for a fracture. Intra-operatively it was noted that one of the supraclavicular nerves was passing through a foramen in the clavicle shaft. A 60-year-old gentleman presented with a displaced multifragmentary fracture of the left clavicle after a fall. Plate fixation with a pre-contoured locking plate was performed under general anaesthesia. The clavicle was exposed through an infraclavicular transverse incision. It was necessary to divide this transosseous nerve branch to permit appropriate plate positioning. Post-operatively the patient was left with some incisional chest numbness. Surgeons should aim to preserve the branches of the supraclavicular nerve although this may not always be possible as we have demonstrated. The patient should be warned about potential deficit.