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Comparison of supraclavicular nerve injuries after clavicle mid-shaft surgery via minimally invasive plate osteosynthesis versus open reduction and internal fixation

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Only a few previous studies have evaluated the factors related to supraclavicular nerve (SCN) injury after clavicle mid-shaft fracture surgery. We analyzed the frequency and risk factors for SCN injury after clavicle mid-shaft fracture surgery via open reduction and internal fixation (ORIF) versus minimally invasive plate osteosynthesis (MIPO)

Materials and methods

We retrospectively reviewed the cases from 59 patients who had undergone surgery for clavicle mid-shaft fractures between January 2018 and April 2019. Twenty-nine patients had undergone ORIF and 30 had undergone MIPO. The frequency of SCN injury in the two groups was evaluated, and preoperative patient demographics (age, sex, body mass index, smoking, alcohol, diabetes mellitus, and trauma mechanism), and radiological parameters (fracture displacement and shortening) were measured and evaluated as risk factors for SCN injury. When neurological symptoms, such as numbness, were present on the anterior chest wall or at the incision site, electromyography (EMG) was conducted.

Results

Neurological symptoms were present in 12 patients. Numbness in the anterior upper chest around the incision site was present in eight and four patients who underwent ORIF and MIPO, respectively (p < 0.001). Furthermore, fracture displacement evaluated on preoperative three-dimensional computed tomography was significantly associated with the occurrence of SCN injury in patients who underwent MIPO (odds ratio, 1.038; 95% confidence interval, 1.001–1.077; p = 0.047). Although EMG was conducted in all patients with SCN injury, peripheral neuropathy was not found in any cases.

Conclusions

SCN injury, which is a possible complication of clavicle mid-shaft fracture surgery, occurred significantly less frequently in MIPO than in ORIF. In MIPO, greater preoperative fracture displacement was associated with a higher risk of SCN injury. Additional studies are required to reach a consensus regarding accurate methods to evaluate SCN injuries.

Level of evidence

IV, case series, treatment study

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Shoulder and Elbow Clinic, College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea

    Sang-Hun Ko

  2. Department of Orthopaedic Surgery, Shoulder and Elbow Clinic, College of Medicine, Kyung Hee University Hospital At Gangdong, Seoul, Republic of Korea

    Myung-Seo Kim

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Contributions

S-HK: Study design, performed surgeries. M-SK: Writing the paper, proof reading.

Corresponding author

Correspondence to Myung-Seo Kim.

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We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We understand that the Corresponding Author is the sole contact for the Editorial process. He is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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This study was approved by our institutional review board (Ulsan University Hospital, UUH 2020-05-009). The study has been performed in accordance with the ethical standards in the 1964 Declaration of Helsinki and with relevant regulations of the US Health Insurance Portability and Accountability Act.

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Ko, SH., Kim, MS. Comparison of supraclavicular nerve injuries after clavicle mid-shaft surgery via minimally invasive plate osteosynthesis versus open reduction and internal fixation. Arch Orthop Trauma Surg 142, 1895–1902 (2022). https://doi.org/10.1007/s00402-021-03941-w

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  • DOI: https://doi.org/10.1007/s00402-021-03941-w

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