Cutaneous paresthesia after internal plate fixation of clavicle fractures and underlying anatomical observations

Clinical outcomes of Nice knot-assisted locking plate for preserving periosteum internal fixation in comminuted clavicle fractures: A retrospective study

IntroductionClavicular fractures, particularly comminuted fractures, are common injuries that can affect shoulder function and upper limb mobility. The management of these fractures, especially using surgical approaches and fixation methods, remains a key area of clinical focus. Preserving the periosteum during surgery may improve fracture healing and reduce complications. This study explored the clinical efficacy of a periosteum-preserving surgical technique combined with a Nice knot-assisted locking plate for treating comminuted clavicular fractures.MethodsA total of 85 patients with comminuted clavicular fractures were included in this retrospective study. According to the Allman classification, 56 (65.9%) cases were type IC, 19 (22.4%) were type II, 9 (10.9%) were type III, and 1 (1.1%) involved comminuted fractures across the entire clavicle. All patients underwent surgical treatment using a periosteum-preserving approach combined with a Nice knot-assisted locking plate. Fracture healing time, upper limb function (measured via Constant-Murley score and disabilities of the arm, shoulder, and hand questionnaire), and postoperative complications were assessed 6 and 12 months postoperatively.ResultsThe median healing time was 13 weeks, with no cases of nonunion reported. At 6 months postoperatively, the Constant-Murley and disabilities of the arm, shoulder, and hand scores were excellent. Although a statistically significant difference (P < 0.05) was observed in these scores between 6 and 12 months, all patients reported satisfactory recovery of shoulder function and upper limb mobility. No significant differences (P > 0.05) in fracture healing time or upper limb function recovery were observed across different types of clavicular fractures. Six (7.1%) patients experienced temporary numbness in the subclavian region, which gradually resolved by the final follow-up.ConclusionThe periosteum-preserving approach with Nice knot-assisted locking plate fixation proved to be an effective and reliable treatment for comminuted clavicular fractures. The technique was associated with favorable healing times, excellent functional outcomes, and low complication rates. Preservation of the periosteum and soft tissue during surgery may considerably reduce intraoperative trauma and improve postsurgical recovery. Further studies with larger sample sizes and longer follow-up periods are needed to confirm the long-term benefits of this approach.

Minimally Invasive Plate Osteosynthesis with Mini-Open Technique and Supraclavicular Nerve Preservation Reduces Postoperative Numbness in Acute Displaced Midshaft Clavicle Fracture

Background: Minimally invasive plate osteosynthesis (MIPO) for clavicular shaft fracture yields favorable functional outcomes and results in less surgery-related soft tissue injury than other techniques. Anterior chest and shoulder skin numbness, a common complication after open reduction and plate fixation, is related to injury to the supraclavicular nerves. We propose MIPO combined with a mini-open approach without fluoroscopy for nerve preservation to minimize the risk of postoperative numbness compared with traditional open plating without nerve preservation. Methods: A total of 59 patients were retrospectively identified, with a follow-up period of 6 months. Thirty-two patients underwent MIPO with mini-open and nerve preservation technique (MIPO group), and 27 patients underwent traditional open plating without nerve preservation (open group). Constant-Murley shoulder outcome score, operation time, wound length, skin numbness, and number of implant removals were compared between the groups. Results: The MIPO group had significantly lower rates of anterior chest and shoulder skin numbness than the open group (MIPO: 12.5% vs. open: 55.6%; p < 0.001). Operation time was significantly longer in the MIPO group than in the open group (MIPO: 109.38 ± 18.83 vs. open: 81.48 ± 18.85; p < 0.001). Wound length was significantly shorter in the MIPO group than in the open group (MIPO: 4.73 ± 0.79 vs. open: 9.76 ± 1.64; p < 0.001). Both groups had similarly excellent Constant-Murley shoulder scores. There were significantly fewer implant removals in the MIPO group than in the open group (MIPO: 6.3% vs. open: 25.9%; p = 0.036). Neither group experienced any infection, implant failure, or nonunion. Conclusions: Our technique combining MIPO with the mini-open approach and supraclavicular nerve preservation yields a lower incidence of skin numbness than traditional open plating without nerve preservation.

[Clavicle shaft fractures in childhood and adolescence : Consensus report of the Pediatric Traumatology Section of the German Society for Trauma Surgery]

INTRODUCTION

Clavicle shaft fractures are among the most common fractures in childhood and adolescence. In the past they were almost exclusively treated conservatively but in recent years there has been an increase in surgical treatment. Nevertheless, exact recommendations for the choice of diagnostics and for the treatment regimen do not yet exist.

MATERIAL AND METHODS

Therefore, our aim was to develop a consensus within the 7th scientific working meeting of the section for pediatric traumatology in the German Society for Trauma Surgery based on expert opinion.

RESULTS

Single-plane radiographic imaging is considered the gold standard diagnostic tool. Children younger than 10 years are primarily treated conservatively, and the type of immobilization is secondary. In girls older than 12 years and boys older than 14 years, fractures dislocated by more than the shaft width and shortened by > 2 cm should be treated by open reduction and stabilized by osteosynthesis, followed by free-functional follow-up treatment.

CONCLUSION

In addition to X‑rays, diagnostics using ultrasound must be further established. Treatment continues to be primarily conservative, but surgical treatment is also important, especially in adolescents. If the indications are correct, a good outcome can be expected regardless of the choice of treatment.

Pilot feasibility study of a simple regenerative peripheral nerve interface designed to diminish cutaneous dysesthesia after supraclavicular operations

Supraclavicular operations can be associated with postoperative cutaneous dysesthesia and hypersensitivity. Regenerative peripheral nerve interfaces, created by attaching the proximal end of a divided peripheral nerve into a viable muscle target, can promote neurite regrowth and neuromuscular connections to help suppress painful nerve hyperactivity. During 40 consecutive operations for neurogenic thoracic outlet syndrome, we demonstrated that division of at least one of the superficial supraclavicular cutaneous sensory nerve branches was necessary in 98% of cases. We subsequently developed a novel regenerative peripheral nerve interface for supraclavicular operations using the adjacent omohyoid muscle and have described the technical steps involved in this procedure.

Surgical Versus Nonsurgical Treatment of Lateral Clavicle Fractures: A Short-Term Follow-Up of Treatment and Complications in 122 Patients

OBJECTIVES

To assess the total number of procedures in initially surgically and nonsurgically treated patients with lateral clavicle fractures and to compare patient-reported outcome measures (PROMs).

DESIGN

Retrospective cohort study.

SETTING

Level 1 trauma center.

PATIENTS

One hundred twenty-two patients with lateral clavicle fractures treated at Uppsala University Hospital from 2013 to 2015 were included in a patient record review. A subgroup of 30 patients was assessed at a study follow-up visit at a median of 3 years postinjury.

INTERVENTION

Comparisons between initially surgically and nonsurgically treated patients.

MAIN OUTCOME MEASUREMENTS

Rates of surgical treatment, reoperations, and delayed surgeries. PROM subgroup: Constant score; Disabilities of the Arm, Shoulder and Hand score; and Visual Analog Scale over satisfaction with the cosmetic results and interview-based information on subjective complaints and reflections.

RESULTS

Of 23 surgically treated patients (22 Neer type II and V fractures), 10 underwent subsequent implant removal, after which 1 developed symptomatic nonunion. Of 99 nonsurgically treated patients (36 Neer type II and V fractures), 2 underwent delayed surgery because of symptomatic nonunion. In the PROM subgroup, the surgically treated patients had worse Constant scores, complained of infraclavicular sensory deficits, and were less satisfied with the cosmetic result than the nonsurgically treated patients.

CONCLUSIONS

Half of the surgically treated patients underwent implant removal, whereas delayed surgeries in nonsurgically treated patients were very rare. Nonsurgical treatment should be considered more often as an alternative to surgery even for the usually surgically treated Neer type II and V lateral clavicle fractures.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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

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.