Morphological Study of Attachment of Costoclavicular Ligament on the Dry Human Clavicles in North Indian Population

INTRODUCTION

The costoclavicular ligament of the sternoclavicular region plays a significant role to deliver strength as well as movements of the pectoral girdle.^1,2 The costoclavicular ligament provides stability to the sternoclavicular joint.^3,4 This ligament ranges from the 1st costal cartilage and the contiguous part of the first rib to the lower surface of the medial part of the shaft of the clavicle.⁵ This ligament presents in various shapes as anteroposteriorly i.e., flattened, cone shape, inverted, truncated cone. The impressive part of the costoclavicular ligament on the clavicle bears an impression in the form of a rough impression, tubercle rough oval, or depressed area which is also called a rhomboid fossa.^6–8 This ligament is susceptible to damage in Craftsmen, painters, and mariners.^9–11 This ligament can comprise hyperostotic variations on the medial end of the clavicle.¹¹ The rhomboid fossa is the very helpful morphological attribute to estimate age and sex.¹² Remnants of some bones such as the skull, pelvis, bones of an upper and lower limb, sternum, and patella are used for estimation of sex and age. But clavicle also has been used for the identification of unknown individuals as it is relatively resistant to environmental degradation so it is more reliable for the determination of sex.¹³ The usual morphological variants of the attachment region of the costoclavicular ligament on the clavicle may be misjudged as pathological situations by an inexpert viewer.¹⁴ Rhomboid impression also acts as a landmark for determining the extent of resection of the medial end of the clavicle bone.¹⁵ The subclavian vein which lies posterior to the costoclavicular ligament plays a vital role during procedures like venous catheterization.^16–18

MATERIALS AND METHODS

To study the morphology of rhomboid impression or the area of attachment of the costoclavicular ligament on the clavicle, the bones were obtained from the Anatomy Department of Sri Guru Ramdas Institute of Health and Sciences, Amritsar. Total of 100 clavicle bones were studied, out of which 50 were on the right side and 50 were on the left side. The various patterns of the impression were observed.

Morphology of rhomboid impression or costoclavicular ligament were observed for the following features:

• Impression: Rhomboid impression present or absent.

• Pattern of impression: Flat and smooth (FS), flat and rough (FR), elevated and rough (ER), depressed and rough (DR) and no impression.

RESULT

The sternal end of the clavicle bone showed an impression of its inferior aspect. This area was reflected in different patterns of impression. In this study, 100 dry human clavicles of unknown age and sex were studied out of which 50 right and 50 left sides were taken and different patterns of impressions were perceived. Out of 100 bones, only 83 bones were comprised of diverse impressions, the remaining 17 bones out of which eight of right side and nine of left side impression was found to be absent (Table 1). The different patterns of impression were observed mentioned in (Table 2). Flat and smooth (FS): Found in 18 bones (18%) (Fig. 1). Flat and rough (FR): Found in 19 bones (19%) (Fig. 2). Elevated and rough (FR): Were present in 33 bones (33%) (Fig. 3). Depressed and rough (DR) present in 13 bones (13%) (Fig. 4). No impression found in 17 bones (17%) (Fig. 5). In our study, Chi-square test is applied in Table 1 and the (p = 0.789) value found is not statistically highly significant. In Table 2, value (p = 0.978) found which was also not statistically significant (Table 3).

DISCUSSION

On the undersurface of the clavicle towards its sternal end, a rough oval impression is usually present for the attachment of the costoclavicular ligament called a rhomboid impression. According to Williams et al., rarely, this area is smooth or even raised and may form a synovial joint with the first rib.⁸

There are various patterns for the attachment area of the costoclavicular ligament, i.e., elevated and rough, flat and rough, flat and smooth, and depressed and rough. A deficiency of knowledge of the differences in the attachment area of the costoclavicular ligament can lead to diagnostic errors. Depressed and rough area on the rhomboid fossa may lead to the misapprehension of chronic osteomyelitis.¹

Cave studied a flat and rough, flat and smooth, elevated and rough and depressed and rough impression for costoclavicular ligament, i.e., 31, 29.1, 8.5, and 18%, respectively.¹ On the other side, Paraskevas et al. in their radiological study observed that the various morphological patterns as mentioned above are 58.12, 26.88, and 15%, respectively.¹⁹

According to Flournoy et al.,²⁰ diverse characters detected on the costoclavicular ligament of the clavicle in the North American population and defined them as rough impressions, tubercles, and grooves like fossa called rhomboid fossa, occasionally there is no impression.

In a study carried out at Lucknow by Anita Rani and her coworkers, rhomboid fossa was the most common outcome in clavicles of Indian origin.²¹ Even the absence of costoclavicular ligament has been described by Tubbs et al.^22–28

In our present study following findings were observed in 100 clavicles 50 on the right side and 50 on the left side with unknown age and sex. In our study, we reported flat and smooth in 18 bones (18%), flat and rough in 19 bones (19%), elevated and rough in 33 bones (33%), and depressed and rough in 13 bones (13%). Even in 17 bones (17%) impressions were absent.

CONCLUSION

The most common morphological pattern of the rhomboid fossa is elevated and rough. A rhomboid fossa is very useful to determine the age of an unknown individual. This fossa is playing a vital role in sex determination. The knowledge of the costoclavicular impression area is clinically beneficial for orthopaedical, radiological, and also for forensic as well as anthropological points of view.

ACKNOWLEDGMENT

The author would like to gratitude to all the faculty members of Department of Anatomy for their assistance during my research work.

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