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Ma T, Su H, Lu Y, Chen J, Tan W, Lei F, Wang D. Efficacy of intramedullary bridge fixation for midshaft clavicle fractures: a retrospective analysis of a novel technique. J Orthop Traumatol 2024; 25:31. [PMID: 38864994 PMCID: PMC11169189 DOI: 10.1186/s10195-024-00771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/25/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND The aim of this study was to explore the efficacy of a novel intramedullary fixation technique using the ortho-bridge system (OBS) for midshaft clavicle fractures. METHODS A total of 63 patients were included in this study: 35 underwent plate internal fixation (LP group) and 28 underwent OBS intramedullary fixation (OBS group). Surgical time, intraoperative blood loss, incision length, fracture healing time, removal of the internal fixation agent, visual analog scale (VAS) score for shoulder pain, Constant-Murley shoulder score and complication occurrence were compared between the two groups. RESULTS Preoperative general data, such as sex, age and fracture type, were not significantly different between the two groups (P > 0.05). However, the OBS group exhibited better outcomes than the LP group exhibited in terms of surgical time, intraoperative blood loss and total incision length (P < 0.05). Additionally, the OBS group exhibited a significantly shorter fracture healing time and internal-fixation removal time than the LP group exhibited (P < 0.05). The VAS scores on postoperative day 1, week 1, month 1 and month 3 were lower in the OBS group than in the LP group (P < 0.05). Furthermore, the Constant-Murley shoulder scores at 1, 3, and 6 months postoperatively were higher in the OBS group than in the LP group (P < 0.05), with no significant difference at 1 year after surgery (P > 0.05). None of the patients in the OBS group experienced scarring of the surgical incision, and 6 patients in the LP group experienced scarring of the surgical incision. Finally, the complication incidence in the OBS group was lower than that in the LP group. CONCLUSION For midshaft clavicle fractures, OBS intramedullary fixation is better than locking-plate internal fixation because it led to less trauma, a faster recovery, better efficacy, and better esthetic outcomes and comfort. Therefore, this technique may have potential as a novel treatment for midshaft clavicle fractures. LEVEL OF EVIDENCE III, retrospective observational study.
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Affiliation(s)
- Tianyong Ma
- Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100, China
| | - Huan Su
- Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100, China
| | - Yihong Lu
- Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100, China
| | - Junping Chen
- Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100, China
| | - Weiyuan Tan
- Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100, China
| | - Fang Lei
- Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100, China
| | - Dewei Wang
- Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100, China.
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Hornung CM, Kramer R, Levine J, Hannink G, Hoogervorst P. Functional outcomes and complications of plate fixation for midshaft clavicle fractures by type and location: a systematic review and meta-analysis. JSES Int 2024; 8:407-422. [PMID: 38707570 PMCID: PMC11064701 DOI: 10.1016/j.jseint.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background Various plate types are used in the surgical treatment of displaced midshaft clavicle fractures. These plates can be positioned in different locations on the clavicle, although no studies to date have elucidated optimal plate type and location of fixation. This systematic review compares the functional outcomes and complications in the management of displaced midshaft clavicle fractures using plate fixation by stratifying by both plate type and location. Methods A systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted to identify all papers reporting functional outcomes, union rates, and/or complications using plates for the management of midshaft clavicle fractures. Multiple databases and trial registries were searched from inception until March 2022. A meta-analysis was conducted for functional outcomes and type of complication, stratified by plate type (locking, compression, or reconstruction) and location (superior or anteroinferior). Pooled estimates of functional outcome scores and incidence of complications were calculated using a random effects model. Risk of bias and quality were assessed using the risk of bias version 2 and ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tools. The confidence in estimates were rated and described according to the recommendations of the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) working group. Results Forty-five studies were included in the systematic review and 43 were included in the meta-analysis. Depending on plate type and location, pooled Constant-Murley Scores ranged from 89.23 to 93.48 at 12 months. Nonunion rates were 3% (95% confidence interval [CI] 1-6) for superior locking plates (GRADE Low). Rates of any complication (nonunion, hardware failure, hardware irritation, wound dehiscence, keloid, superficial infection, deep infection, delayed union, malunion, and/or persistent pain) by plate type and location ranged from 3% to 17% (GRADE Very Low to Moderate). Superior compression plates had the highest incidence of any complications (17% [95% CI 5-44], GRADE Very Low), while anterior inferior compression plates had the lowest incidence of any complication (3% [95% CI 0-15], GRADE Very Low). Hardware irritation was the most reported individual complication for superior locking plates and superior compression plates, 11% (95% CI 7-17, GRADE Low) and 11% (95% CI 3-33, GRADE Very Low), respectively. Conclusion Although most studies were of low quality, studies reporting functional outcomes generally showed good functional results and similar incidence of any complication regardless of plate type and location. There is no evidence of a plate and location combination to optimize patient functional outcomes or complications. We were unable to reliably evaluate union rates or individual complications for most plate types stratified by location.
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Affiliation(s)
- Christopher M. Hornung
- Department of Orthopaedic Surgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Riley Kramer
- Department of Orthopaedic Surgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Joshua Levine
- Department of Orthopaedic Surgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Gerjon Hannink
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul Hoogervorst
- Department of Orthopaedic Surgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
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Jirangkul P, Kosiyatrakul A, Lorsuwannarat N. Minimally invasive plate osteosynthesis for displaced midshaft clavicle fractures: An indirect reduction using joystick technique. J Orthop Sci 2023; 28:1365-1372. [PMID: 36184268 DOI: 10.1016/j.jos.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 07/11/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND A minimally invasive plate osteosynthesis (MIPO) technique has become increasingly popular in long bone fracture fixation as it could eliminate postoperative complications. However, the most challenging aspect of employing the MIPO for midshaft clavicle fractures among general orthopedic surgeons is the technically demanding that indirect reduction is typically a closed maneuver. METHODS We present a consecutive series of patients with displaced midshaft clavicle fractures undergoing clavicular fixation using the MIPO technique between January 2017 and October 2019. The joystick technique was used to obtain anatomical reduction. Clinical outcomes were assessed using the Constant-Murley and the American shoulder and elbow surgeons shoulder scores. RESULTS Thirty patients with a mean age of 42.44 years were included. The functional shoulder scores showed no disabilities compared with those of a healthy population. No major complications requiring re-operation were noted, and all fractures were completely healed with an average time of 12.53 weeks. CONCLUSION This study demonstrated that facilitating the MIPO for midshaft clavicle fractures using simple operative devices and techniques was possible. The joystick technique with the use of an external fixator for temporary stabilization is a safe and effective method that can be added to achieve anatomical alignment with the fracture site unexposed. This technique could be performed either in a fresh fracture or a delayed case with failed conservative treatment.
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Affiliation(s)
- Puripun Jirangkul
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
| | - Arkaphat Kosiyatrakul
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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Hu R, Su YJ, Chien CS. Supraclavicular nerve sparing versus sacrifice during open reduction internal fixation of acute midshaft clavicle fracture. J Orthop Surg Res 2023; 18:725. [PMID: 37749619 PMCID: PMC10518922 DOI: 10.1186/s13018-023-04220-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/19/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The branches of the supraclavicular nerve are often sacrificed during open reduction and internal fixation (ORIF) for clavicle fracture. No consensus exists on whether the supraclavicular nerve should be routinely identified and protected during ORIF. METHODS We developed a simple method to make nerve sparing easier; Wide-Awake Local Anesthesia No Tourniquet (WALANT) solution is locally injected prior to the surgical incision being made. This retrospective study enrolled 340 patients and divided them into supraclavicular-nerve-sparing (n = 45) and supraclavicular-nerve-sacrifice (n = 295) groups. Surgical outcomes-including operative time, estimated blood loss, postoperative pain, union rate, time to union, functional score, paresthesia, complications, implant removal rate, and complication rate-were recorded. RESULTS Incisional or anterior chest wall numbness and intraoperative blood loss were significantly less (p < 0.001) in the nerve-sparing group. The operative time was similar in the two groups. No significant differences were discovered in QuickDASH score, postoperative pain score, union rate, time to union, implant removal rate, complication rate, or revision rate. CONCLUSIONS Our study demonstrated that the outcomes of supraclavicular nerve sparing during ORIF with WALANT can reduce postoperative incisional and anterior chest wall numbness and intraoperative blood loss without increasing the operative time or complication rate.
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Affiliation(s)
- Ruei Hu
- Orthopedics Department, Chi-Mei Medical Center, Tainan, Taiwan.
- Department of Orthopaedics, Kaohsiung Municipal Ta-Tung Hospital, KaoHsiung, Taiwan.
| | - Yu-Jung Su
- Orthopedics Department, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chi-Sheng Chien
- Orthopedics Department, Chi-Mei Medical Center, Tainan, Taiwan
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Lorsuwannarat N, Jirangkul P. Safe zone of supraclavicular nerve during clavicle fixation and its anatomical variations, a cadaveric study. Arch Orthop Trauma Surg 2023; 143:5677-5685. [PMID: 37099162 DOI: 10.1007/s00402-023-04874-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/03/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND Supraclavicular nerve injury is usually at risk during clavicular fracture fixation. This study aimed to examine the anatomical features and estimate the precise location of supraclavicular nerve branches related to adjacent structural landmarks and to evaluate the differences between sex and side. To highlight the clinical purposes and surgical relevance, this study attempted to define a surgical safe zone that would probably protect the supraclavicular nerve during clavicle fixation. METHOD A total of 64 shoulders obtained from 15 female and 17 male adult cadavers were examined, identifying the branching patterns of the supraclavicular nerve, measuring the clavicle length and the course of the supraclavicular nerve referring to the sternoclavicular (SC) and acromioclavicular (AC) joint. Data were categorized by sex and side, and their differences were evaluated using Student T-Test and Mann-Whitney U Test. Clinically relevant predictable safe zones were also statistically analyzed. RESULT The results revealed 7 branching patterns of the supraclavicular nerve. The medial and lateral nerve branches formed a shared trunk, and the medial nerve branches separated to form the intermediate branch, i.e., the most frequent pattern (67.19%). The safe zones were determined to be 6.1 mm among both sexes of the SC joint medially, and 0.7 mm among females and 0 mm among males of the AC joint laterally. Surgical incisions between 29.3 to 51.2% and 60.5 to 79.7% of the clavicle length from the SC joint were the safe zones at the midclavicular shaft among both sexes. CONCLUSION The findings of this study have provided new insights into the anatomy of the supraclavicular nerve and its variations. It has been revealed that the terminal branches of the nerve consistently pass over the clavicle in a predictable pattern, emphasizing the importance of considering the supraclavicular nerve's safe zones during clinically relevant surgeries. Nevertheless, due to individual anatomical variations, meticulous dissection between these safe zones is necessary to avoid iatrogenic nerve injury among patients. LEVEL OF EVIDENCE Basic Science Study, Anatomic Study.
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Affiliation(s)
| | - Puripun Jirangkul
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
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Lee CCM, Beh ZY, Lua CB, Peng K, Fathil SM, Hou JD, Lin JA. Regional Anesthetic and Analgesic Techniques for Clavicle Fractures and Clavicle Surgeries: Part 1-A Scoping Review. Healthcare (Basel) 2022; 10:1487. [PMID: 36011144 PMCID: PMC9408139 DOI: 10.3390/healthcare10081487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
Objective. Clavicle fractures are common injuries potentially associated with significant perioperative pain. However, this region's complex sensory innervation poses a challenge for regional anesthetic or analgesic (RA) techniques. We conducted this scoping review to summarize the current literature, particularly with regards to motor-sparing techniques. Methods. A scoping review was carried out in accordance with the Joanna Briggs Institute's framework. All articles describing the use of RA for clavicle fractures or surgery were included. PubMed®, Ovid MEDLINE®, EMBASE®, Scopus®, CINAHL®, and the Cochrane database were searched without language restrictions. Results. Database searches identified 845 articles, 44 of which were included in this review, with a combined patient total of 3161. We included all peer-reviewed publications containing clinical data and summarized the findings. Conclusions. Current evidence of RA techniques in clavicle surgery is heterogeneous, with different approaches used to overcome the overlapping sensory innervation. The literature largely comprises case reports/series, with several randomized controlled trials. Intermediate cervical plexus block is the regional technique of choice for clavicle surgery, and can provide reliable surgical anesthesia when combined with an interscalene block. Cervical plexus block can provide motor-sparing analgesia following clavicle surgery. Promising alternatives include the clavipectoral block, which is a novel motor-sparing regional technique. Further studies are required to determine the efficacy and safety of various techniques.
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Affiliation(s)
- Chang Chuan Melvin Lee
- Department of Anesthesia, Toowoomba Base Hospital, Darling Downs Hospital and Health Service, Brisbane, QLD 4350, Australia
- Rural Clinical School, Toowoomba Regional Clinical Unit, University of Queensland, Brisbane, QLD 4350, Australia
- Department of Anesthesia, National University Health System, Singapore 119074, Singapore
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Zhi Yuen Beh
- OSC Orthopaedic Specialist Centre, Subang Jaya 47600, Malaysia
- Department of Anesthesiology, Assunta Hospital, Petaling Jaya 46990, Selangor, Malaysia
| | - Chong Boon Lua
- Department of Anesthesia, National University Health System, Singapore 119074, Singapore
| | - Kailing Peng
- Department of Anesthesia, National University Health System, Singapore 119074, Singapore
| | - Shahridan Mohd Fathil
- Department of Anesthesiology, Gleneagles Hospital Medini, Nusajaya 79250, Malaysia
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Jin-De Hou
- Division of Anesthesiology, Hualien Armed Forces General Hospital, Hualien 97144, Taiwan
- Department of Anesthesiology, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Jui-An Lin
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Department of Anesthesiology, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Pain Research Center, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Department of Anesthesiology, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Anesthesiology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
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Ankers T, Sawalha S, Nixon M, Kenyon P, Webb M. Does a skin incision along Langer's lines reduce complications following fixation of displaced middle-third clavicle fractures? Arch Orthop Trauma Surg 2022; 142:1003-1007. [PMID: 33555400 DOI: 10.1007/s00402-021-03766-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/01/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Internal fixation of displaced middle-third clavicle fractures is a widely used treatment but is frequently associated with post-operative complications. The aim of this study is to investigate whether or not using a skin incision along Langer's lines, as opposed to a traditional transverse incision, reduces complications. METHODS We retrospectively reviewed data on 108 patients who underwent open reduction and internal fixation of mid-shaft clavicle fractures between 2014 and 2018. Either an oblique incision along Langer's lines or a transverse incision was used according to surgeon's preference. A pre-contoured diaphyseal locking plate was used in all cases. We collected data on fracture classification, minor complications (irritation from plate, chest wall numbness, superficial wound infection) and major complications (irritation from plate necessitating metalwork removal, periprosthetic fracture, deep infection, neurovascular injury and non-union). Statistical analysis was performed using multivariant regression analysis and Fisher's exact tests. RESULTS Fifty-seven patients underwent fixation using the oblique incision and 51 via the transverse incision. Age, gender and fracture pattern in the two groups were comparable. There were 14 minor and 6 major complications in the oblique group. In the transverse group, there were 16 minor and 5 major complications. The major complication rate was 10.5% in the oblique group and 9.8% in the transverse group. The overall major complication rate was 10.2%. No statistically significant difference in the rate of complications between the two groups was identified. CONCLUSION Based on our data, an incision following Langer's lines does not reduce the rate of complications following fixation of displaced middle-third clavicle fractures.
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Affiliation(s)
- Thomas Ankers
- Countess of Chester Hospital, Chester, UK. .,Countess of Chester Hospital, Liverpool Road, Chester, CH2 1UL, UK.
| | - Seif Sawalha
- Countess of Chester Hospital, Liverpool Road, Chester, CH2 1UL, UK
| | - Matthew Nixon
- Countess of Chester Hospital, Liverpool Road, Chester, CH2 1UL, UK
| | - Peter Kenyon
- Countess of Chester Hospital, Liverpool Road, Chester, CH2 1UL, UK
| | - Mark Webb
- Countess of Chester Hospital, Liverpool Road, Chester, CH2 1UL, UK
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Lemieux V, Afsharpour S, Nam D, Elmaraghy A. Incisional paresthesia following clavicle plate fixation: does it matter to patients? BMC Musculoskelet Disord 2021; 22:928. [PMID: 34732198 PMCID: PMC8567600 DOI: 10.1186/s12891-021-04770-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022] Open
Abstract
Background Operative management of clavicle fractures is increasingly common. In the context of explaining the risks and benefits of surgery, understanding the impact of incisional numbness as it relates to the patient experience is key to shared decision making. This study aims to determine the prevalence, extent, and recovery of sensory changes associated with supraclavicular nerve injury after open reduction and plate internal fixation of middle or lateral clavicle shaft fractures. Methods Eighty-six patients were identified retrospectively and completed a patient experience survey assessing sensory symptoms, perceived post-operative function, and satisfaction. Correlations between demographic factors and outcomes, as well as subgroup analyses were completed to identify factors impacting patient satisfaction. Results Ninety percent of patients experienced sensory changes post-operatively. Numbness was the most common symptom (64%) and complete resolution occurred in 32% of patients over an average of 19 months. Patients who experienced burning were less satisfied overall with the outcome of their surgery whereas those who were informed of the risk of sensory changes pre-operatively were more satisfied overall. Conclusions Post-operative sensory disturbance is common. While most patients improve, some symptoms persist in the majority of patients without significant negative effects on satisfaction. Patients should always be advised of the risk of persistent sensory alterations around the surgical site to increase the likelihood of their satisfaction post-operatively. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04770-z.
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Affiliation(s)
- Valérie Lemieux
- Department of Surgery - Division of Orthopaedic Surgery, University of Toronto, 149 College Street, Toronto, Ontario, M5T 1P5, Canada. .,Sunnybrook Health Sciences Centre, Toronto, Canada.
| | - Soheil Afsharpour
- Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Diane Nam
- Department of Surgery - Division of Orthopaedic Surgery, University of Toronto, 149 College Street, Toronto, Ontario, M5T 1P5, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Amr Elmaraghy
- Department of Surgery - Division of Orthopaedic Surgery, University of Toronto, 149 College Street, Toronto, Ontario, M5T 1P5, Canada.,Division of Orthopaedic Surgery, St. Joseph's Health Centre, Unity Health Toronto, Toronto, Canada
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Comparison of patient reported outcomes following clavicle operative fixation using supraclavicular nerve sparing and supraclavicular nerve sacrificing techniques- A cohort study. Injury 2021; 52:501-505. [PMID: 33131791 DOI: 10.1016/j.injury.2020.10.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Supraclavicular nerve injury is one of the common complications after clavicle open reduction internal fixation (ORIF) affecting up to 55% of patients. There is debate about whether sparing supraclavicular nerves improves functional outcomes and patient satisfaction. The purpose of this study was to compare numbness, patient-reported outcomes and surgical time in patients undergoing clavicle ORIF using supraclavicular nerve sparing and supraclavicular nerve sacrificing techniques. PATIENTS AND METHODS We conducted a retrospective cohort study with prospective survey of 108 patients with clavicular fractures treated with ORIF at a level 1 trauma centre. Patients were divided into two groups: 1) ORIF with supraclavicular nerve sparing techniques and 2) ORIF with supraclavicular nerve sacrificing techniques. Questionnaires were conducted and subjective numbness around supraclavicular nerve distribution was our primary outcome measure. Secondary outcome measures included the Quick Disability of the Arm, Shoulder and Hand (QuickDASH) score, a numeric rating scale for pain and satisfaction with treatment and surgical time. RESULTS An overall response rate of 92% was achieved with an average follow-up of 16 months. There were 20 patients in the supraclavicular nerve sparing group and 79 patients in the supraclavicular nerve sacrificing group. 76% of all patients experienced numbness post-operatively and 91% of these patients experienced persistent numbness at final follow-up. There was no significant difference between the groups for age, gender, time to follow-up and mechanism of injury. Patients in the supraclavicular nerve sparing group had significantly less numbness at final follow-up (35% vs 86%, P < 0.001; OR=0.21 95%CI 0.11-0.40). There was no significant difference in the QuickDASH score nor the NRS for pain and function. Sparing supraclavicular nerves did not result in a significantly longer operation. CONCLUSIONS Our study demonstrates that identification and protection of the supraclavicular nerves result in significantly less numbness following clavicle ORIF but does not affect patient reported functional outcomes.
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Anatomy of clavicle in the Indian population and its applicability in pre-contoured plating. INTERNATIONAL ORTHOPAEDICS 2019; 44:699-704. [PMID: 31478071 DOI: 10.1007/s00264-019-04390-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Fractures of the clavicle are traditionally treated non-operatively, but with the increase of high-energy trauma, there has been an increase in the operative management of these fractures. Controversy exists on the type of fixation for middle third clavicle fractures. The anatomically pre-contoured plates are low-profile mechanically sound plates which do not cause much soft tissue irritation. METHODS To characterise the clavicular morphology through computerised tomography and determine the applicability of pre-contoured plates for our population. RESULTS In this study, the mean total length was 145.31 mm and the apex of superior clavicle bow was located 38.15 mm from the acromial end, thereby giving a zone of 107.16 mm for plating. In the 107.16 mm of platable zone, the zone of ideal fracture location was 43.16 mm. Superior anterior plates had a good fit in 89.3% of the CT subset, whereas superior plates had a good fit in only 71.6% of the population. CONCLUSION Superior anterior pre-contoured clavicle plates have approximately 98% good to fair compatibility for clavicles in the South Indian population without any need for further intra-operative moulding.
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Li H, Wang L, Wang H. Comment on article by Chechik et al.: Surgical approach for open reduction and internal fixation of clavicle fractures: a comparison of vertical and horizontal incisions. INTERNATIONAL ORTHOPAEDICS 2019; 43:2649-2650. [PMID: 31471623 DOI: 10.1007/s00264-019-04401-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/16/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Hang Li
- Department of Orthopaedic Surgery, The First People's Hospital of Xiaoshan Hangzhou, No. 199, Shixin South Road, Xiaoshan District, Hangzhou, Zhejiang, China.
| | - Longfeng Wang
- Department of Orthopaedic Surgery, The First People's Hospital of Xiaoshan Hangzhou, No. 199, Shixin South Road, Xiaoshan District, Hangzhou, Zhejiang, China
| | - Hui Wang
- Department of Orthopaedic Surgery, The First People's Hospital of Xiaoshan Hangzhou, No. 199, Shixin South Road, Xiaoshan District, Hangzhou, Zhejiang, China
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