Does a minimal invasive approach reduce anterior chest wall numbness and postoperative pain in plate fixation of clavicle fractures?

Marc Beirer, Lukas Postl, Moritz Crönlein, Sebastian Siebenlist, Stefan Huber-Wagner, Karl F Braun, Peter Biberthaler, Chlodwig Kirchhoff, Marc Beirer, Lukas Postl, Moritz Crönlein, Sebastian Siebenlist, Stefan Huber-Wagner, Karl F Braun, Peter Biberthaler, Chlodwig Kirchhoff

Abstract

Background: Fractures of the clavicle present very common injuries with a peak of incidence in young active patients. Recently published randomized clinical trials demonstrated an improved functional outcome and a lower rate of nonunions in comparison to non-operative treatment. Anterior chest wall numbness due to injury of the supraclavicular nerve and postoperative pain constitute common surgery related complications in plate fixation of displaced clavicle fractures. We recently developed a technique for mini open plating (MOP) of the clavicle to reduce postoperative numbness and pain. The purpose of this study was to analyze the size of anterior chest wall numbness and the intensity of postoperative pain in MOP in comparison to conventional open plating (COP) of clavicle fractures.

Methods: 24 patients (mean age 38.2 ± 14.2 yrs.) with a displaced fracture of the clavicle (Orthopaedic Trauma Association B1.2-C1.2) surgically treated using a locking compression plate (LCP) were enrolled. 12 patients underwent MOP and another 12 patients COP. Anterior chest wall numbness was measured with a transparency grid on the second postoperative day and at the six months follow-up. Postoperative pain was evaluated using the Visual Analog Scale (VAS).

Results: Mean ratio of skin incision length to plate length was 0.61 ± 0.04 in the MOP group and 0.85 ± 0.06 in the COP group (p < 0.05). Mean ratio of the area of anterior chest wall numbness to plate length was postoperative 7.6 ± 5.9 (six months follow-up 4.7 ± 3.9) in the MOP group and 22.1 ± 19.1 (16.9 ± 14.1) in the COP group (p < 0.05). Mean VAS was 2.6 ± 1.4 points in the MOP group and 3.4 ± 1.6 points in the COP group (p = 0.20).

Conclusions: In our study, MOP significantly reduced anterior chest wall numbness in comparison to a conventional open approach postoperative as well as at the six months follow-up. Postoperative pain tended to be lower in the MOP group, however this difference was not statistically significant.

Trial registration: ClinicalTrials.gov NCT02247778 . Registered 21 September 2014.

Figures

Fig. 1
Fig. 1
Operation technique in a fracture of the clavicular midshaft (OTA B2.3; patient 11, MOP group)). (a) anatomical landmarks and estimated skin incision; (b) skin incision to expose the fracture; (c) anatomical fixation of the wedge fragments by using two lag screws; (d) fixation of the plate; (e) stab incisions to drill the medial and lateral plate holes; (f) skin suture
Fig. 2
Fig. 2
Clinical photograph demonstrating the anterior chest wall numbness on the second postoperative day. (a) area of numbness 3 cm2 (patient 11, MOP group); (b) area of numbness 73 cm2 (patient 7, COP group)
Fig. 3
Fig. 3
Radiological outcome of a clavicle midshaft fracture OTA B2.3 (patient 11, MOP group). (a) + (b) preoperative; (c) + (d) postoperative

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Source: PubMed

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