Subjective Evaluation of Subclavicular Hypoesthesia After Open Reduction and Internal Fixation of Clavicle Fractures
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Published:
Aug 17, 2023
Keywords:
Clavicle fracture, internal fixation, numbness, supraclavicular nerve
Main Article Content
Abstract
Introduction: Clavicle fractures account for 4% of adult fractures, with mid-shaft fractures accounting for 80%. Although surgical treatment reduces the risk of pseudarthrosis, malunion, and residual pain, it is not without complications such as regional hypoesthesia (12-29%).
Objective: To determine the prevalence of subclavicular hypoesthesia following open reduction and internal fixation for clavicle fracture, as well as if and how it impacts the patient’s quality of life.
Materials and Methods: A prospective cross-sectional analytical study of patients with displaced clavicle midshaft fractures treated with ORIF between 2018-2021 was performed. The research team used a questionnaire with six items that were completed anonymously. The presence of infraclavicular hypoesthesia, regional pain, and daily life interference was assessed.
Results: Twenty-nine patients treated surgically with a longitudinal approach and with a minimum postoperative follow-up of one year were evaluated. Twenty-two patients (76%) had altered sensitivity, whereas seven (24%) denied the existence of the symptom. In 97% of individuals with subclavicular hypoesthesia, quality of life was impaired minimally or not at all.
Conclusions: Before undergoing surgery, it is important to inform the patient about the risk of cutaneous numbness as a postoperative consequence due to its high frequency but improbable impact on daily activities.
Objective: To determine the prevalence of subclavicular hypoesthesia following open reduction and internal fixation for clavicle fracture, as well as if and how it impacts the patient’s quality of life.
Materials and Methods: A prospective cross-sectional analytical study of patients with displaced clavicle midshaft fractures treated with ORIF between 2018-2021 was performed. The research team used a questionnaire with six items that were completed anonymously. The presence of infraclavicular hypoesthesia, regional pain, and daily life interference was assessed.
Results: Twenty-nine patients treated surgically with a longitudinal approach and with a minimum postoperative follow-up of one year were evaluated. Twenty-two patients (76%) had altered sensitivity, whereas seven (24%) denied the existence of the symptom. In 97% of individuals with subclavicular hypoesthesia, quality of life was impaired minimally or not at all.
Conclusions: Before undergoing surgery, it is important to inform the patient about the risk of cutaneous numbness as a postoperative consequence due to its high frequency but improbable impact on daily activities.
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How to Cite
Pierro, I., Simone, J. P., Forns, G., & Vasallo, M. B. (2023). Subjective Evaluation of Subclavicular Hypoesthesia After Open Reduction and Internal Fixation of Clavicle Fractures. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(4), 419-426. https://doi.org/10.15417/issn.1852-7434.2023.88.4.1721
Section
Clinical Research
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References
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9. Wang L, Ang M, Lee K, Naidu G, Kwek E. Cutaneous hypoesthesia following plate fixation in clavicle fractures.
Indian J Orthop 2014;48(1):10-3. https://doi.org/10.4103/0019-5413.125478
10. Cárdenas G. Osteosíntesis mínimamente invasiva con placa anatómica bloqueada en fracturas desplazadas del tercio medio de clavícula. Acta Ortop Mex 2021;35(5):479-85. https://doi.org/10.35366/104579
11. Devkota P, Acharya B, Pradhan N, Shrestha S, Thakur A, Gyawali B. Minimally-invasive plate osteosynthesis for clavicle fractures. Rev Bras Ortop (Sao Paulo) 2021;57(2):295-300. https://doi.org/10.1055/s-0041-1731358
12. Mendes A Jr, Curado R, Dias J Jr, Neto J, Carrazzone O, Pagán A, et al. Protocol of BRICS: Brazilian multicentric
pragmatic randomized trial of surgical interventions for displaced diaphyseal clavicle fracture study: MIPO versus ORIF for the treatment of displaced midshaft clavicle fractures. BMJ Open 2021;11(10):e052966.
https://doi.org/10.1136/bmjopen-2021-052966
13. O´Neill K, Stutz C, Duvernay M, Schoenecker J. Supraclavicular nerve entrapment and clavicular fracture. J Orthop Trauma 2012;26(6):e63-5. https://doi.org/10.1177/2325967117712235
2. Burnham J, Kim D, Kamineni S. Midshaft clavicle fractures: A critical review. Orthopedics 2016;39(5):e814-21.
https://doi.org/10.3928/01477447-20160517-06
3. Li R, Ke T, Xiong S, Xiong G, Lin Z, Lin F. Comparison of the effectiveness of oblique and transverse incisions in
the treatment of fractures of the middle and outer third of the clavicle. J Shoulder Elbow Surg 2019;28(7):1308-15. https://doi.org/10.1016/j.jse.2019.03.021
4. Li T, He J, Wu J, Qian G, Geng L, Huang H, et al. Supraclavicular nerves protection during open reduction and
internal fixation. Int J Clin Exp Med 2017;10(5):8558-65. Disponible en: https://e century.us/files/ijcem/10/5/ijcem0038714.pdf
5. Shukla D, Rubenstein W, Barnes L, Klion M, Gladstone J, Kim J, et al. The influence of incision type on patient
satisfaction after plate fixation of clavicle fractures. Orthop J Sports Med 2017;5(6):2325967117712235.
https://doi.org/10.1177/2325967117712235
6. Ropars M, Thomazeau H, Huten D. Clavicle fractures. Orthop Traumatol Surg Res 2017;103(1S):S53-S59.
https://doi.org/10.1016/j.otsr.2016.11.007
7. Havet E, Duparc F, Tobenas-Dujardin A, Muller J, Fréger P. Morphometric study of the shoulder and subclavicular innervation by the intermediate and lateral branches of supraclavicular nerves. Surg Radiol Anat 2007;29(8):605-10. https://doi.org/10.1007/s00276-007-0258-5
8. Ou L, Yang L, Zhao J, Su W. Cutaneous paresthesia after internal plate fixation of clavicle fractures and underlying anatomical observations. Medicine (Baltimore) 2018;97(41):e12729. https://doi.org/10.1097/MD.0000000000012729
9. Wang L, Ang M, Lee K, Naidu G, Kwek E. Cutaneous hypoesthesia following plate fixation in clavicle fractures.
Indian J Orthop 2014;48(1):10-3. https://doi.org/10.4103/0019-5413.125478
10. Cárdenas G. Osteosíntesis mínimamente invasiva con placa anatómica bloqueada en fracturas desplazadas del tercio medio de clavícula. Acta Ortop Mex 2021;35(5):479-85. https://doi.org/10.35366/104579
11. Devkota P, Acharya B, Pradhan N, Shrestha S, Thakur A, Gyawali B. Minimally-invasive plate osteosynthesis for clavicle fractures. Rev Bras Ortop (Sao Paulo) 2021;57(2):295-300. https://doi.org/10.1055/s-0041-1731358
12. Mendes A Jr, Curado R, Dias J Jr, Neto J, Carrazzone O, Pagán A, et al. Protocol of BRICS: Brazilian multicentric
pragmatic randomized trial of surgical interventions for displaced diaphyseal clavicle fracture study: MIPO versus ORIF for the treatment of displaced midshaft clavicle fractures. BMJ Open 2021;11(10):e052966.
https://doi.org/10.1136/bmjopen-2021-052966
13. O´Neill K, Stutz C, Duvernay M, Schoenecker J. Supraclavicular nerve entrapment and clavicular fracture. J Orthop Trauma 2012;26(6):e63-5. https://doi.org/10.1177/2325967117712235