Surgical approach for open reduction and internal fixation of clavicle fractures: a comparison of vertical and horizontal incisions

Chechik, Ofir; Batash, Ron; Goldstein, Yariv; Snir, Nimrod; Amar, Eyal; Drexler, Michael; Maman, Eran; Dolkart, Oleg

doi:10.1007/s00264-018-4139-9

Cited by 12 publications

(10 citation statements)

References 12 publications

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“…Common complications of plate fixation include implant-related symptoms, sensory deficits, wound infections, and nonunion. [63][64][65] In adults, 5.6-25% of patients may require a secondary operation for implant removal due to irritation. 63,[66][67] Intramedullary fixation may result in irritation at the entry site due to the protruding end of the nail.…”

Section: Complicationsmentioning

confidence: 99%

Evaluation and Management of Midshaft Clavicle Fractures in Adolescents

Jasty

Heyworth²

2020

Journal of the Pediatric Orthopaedic Society of North America

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The rate of operative fixation for completely displaced mid-shaft clavicle fractures in adolescents has been increasing yearly over the last decade, largely driven by studies of adult populations, in whom the rate of nonunion is approximately 15% with non-operative treatment. However, nonunion and symptomatic malunion in younger populations remain rare. Recent studies suggest that functional outcomes are similar between conservative management and operative fixation in adolescents, with higher rates of complications and slightly decreased time to return to sport with operative fixation. Implant-related symptoms after surgery remains an important consideration, due to potential for reoperation for implant removal. Additionally, the cost of operative fixation is significantly higher than that of non-operative management. The aim of this review is to summarize the salient historical and more recent literature regarding displaced mid-shaft clavicle fractures in order to better understand treatment considerations and the natural history of these fractures in the adolescent.

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Section: Complicationsmentioning

confidence: 99%

Evaluation and Management of Midshaft Clavicle Fractures in Adolescents

Jasty

Heyworth²

2020

Journal of the Pediatric Orthopaedic Society of North America

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“…[ 67 , 68 , 69 , 70 , 71 ]. Either a longitudinal incision along the subcutaneous border of the clavicle or a vertical (necklace) incision along the Langer lines may be used for osteosynthesis using pre-contoured plates, although smaller skin incisions may be used in a minimally invasive approach with plate osteosynthesis or intramedullary fixation devices [ 72 , 73 , 74 , 75 ]. Unstable distal fractures may further require coracoclavicular repair, tension-band wiring, reconstruction, hook plating, or transacromial pinning [ 75 ].…”

Section: Discussionmentioning

confidence: 99%

Regional Anesthetic and Analgesic Techniques for Clavicle Fractures and Clavicle Surgeries: Part 1—A Scoping Review

et al. 2022

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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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“…( Appendix I ) [ 11 , 19 , 23 – 36 ]. However, this rate increases to 52% when the affected area is measured as part of the study protocol suggesting a possibility of under reporting [ 29 , 34 , 36 ]. We report a larger affected size (36.6 cm 2 [+/− 26.9 cm 2 ]) than the weighted average of 26 cm 2 previously reported in the literature, though the variability seen in our findings represents the challenge inherent to patients’ self-estimation.…”

Section: Discussionmentioning

confidence: 99%

“…Fifteen studies, including 836 patients, reported on average, when weighted, a 27% incidence of numbness at approximately 28 months following longitudinal approach to plate fixation of acute clavicle diaphyseal fractures. (Appendix I) [11,19,[23][24][25][26][27][28][29][30][31][32][33][34][35][36]. However, this rate increases to 52% when the affected area is measured as part of the study protocol suggesting a possibility of under reporting [29,34,36].…”

Section: Discussionmentioning

confidence: 99%

“…Incidence varies widely from 6 to 90% (Appendix I). There is a consistent trend of improvement over time, though without full resolution for all patients [11,19,[23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Previous groups have demonstrated good outcomes despite high prevalence of numbness leading them to refute correlation between numbness and patient satisfaction [19,23,31]; whereas You et al [29] concluded that conventional approaches led to discomfort in 74.3% of their patients.…”

Section: Introductionmentioning

confidence: 94%

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Incisional paresthesia following clavicle plate fixation: does it matter to patients?

Lemieux

Afsharpour

Nam

et al. 2021

BMC Musculoskelet Disord

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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.

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Surgical approach for open reduction and internal fixation of clavicle fractures: a comparison of vertical and horizontal incisions

Abstract: Vertical incision results in shorter scars but may be associated with increased incidence of haematomas. Meticulous closure of the subcutaneous tissue is recommended.

Cited by 12 publications

References 12 publications

Evaluation and Management of Midshaft Clavicle Fractures in Adolescents

Evaluation and Management of Midshaft Clavicle Fractures in Adolescents

Regional Anesthetic and Analgesic Techniques for Clavicle Fractures and Clavicle Surgeries: Part 1—A Scoping Review

Incisional paresthesia following clavicle plate fixation: does it matter to patients?

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