Indraneel S Brahme, Geneva Tranchida, Jeffrey D Winter, Gaonhia Y Moua, Patrick Horrigan, Brian Cunningham, Peter A Cole
{"title":"Preservation versus Sacrifice of the Supraclavicular Nerves during Clavicle ORIF: A Randomized Controlled Trial.","authors":"Indraneel S Brahme, Geneva Tranchida, Jeffrey D Winter, Gaonhia Y Moua, Patrick Horrigan, Brian Cunningham, Peter A Cole","doi":"10.1097/BOT.0000000000003013","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To discover postoperative symptom differences between nerve-sparing and nerve-sacrificing techniques during ORIF of clavicle fractures.</p><p><strong>Methods: </strong>Design: Prospective, partially blinded randomized controlled trial.</p><p><strong>Setting: </strong>Single academic Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>Patients with closed, isolated, displaced, midshaft clavicle fractures (OTA/AO 15-2A, -2B, -2C) underwent ORIF and were consented and randomized to a \"nerve-sacrificing\" or \"nerve-sparing\" group.</p><p><strong>Outcome measures and comparisons: </strong>Semmes-Weinstein monofilament used to test for sensation changes around the supraclavicular area, single assessment numerical evaluation (SANE) scores and symptom severity level (SSL) providing patient self-reported changes, and patient morbidity questionnaires were issued at follow-up. One trained research fellow measured and mapped area of anesthesia. Outcomes between \"nerve-sacrificing\" and \"nerve-sparing\" groups were compared.</p><p><strong>Results: </strong>21 patients (median age 41.5, 28.6% female) were randomized to \"nerve-sacrificed\" and 16 (median age 45.6, 18.8% female) to the \"nerve-spared\" group. There were no statistical differences in age or gender ratio (p=0.304 and 0.702 respectively). Longitudinal models including an interaction between group and time, showed cohort differences being driven by 12-weeks (49.3 (95% CLM 7.68, 90.92)) and 24-weeks (23.92 (95%CLM 1.70, 46.14)). While point estimates for the spare group were still lower at 2- and 52-weeks, they were not significantly different between groups. SANE scores and SSL data showed improvements in both cohorts over time, however; there were no statistically significant differences between the groups (p=0.176 and 0.155, respectively).</p><p><strong>Conclusions: </strong>Sparing the supraclavicular nerve during open reduction and internal fixation of clavicle fractures significantly decreased chest-wall area of anesthesia at 12- and 24-weeks postoperatively. However, nerve sparing did not provide clinically significant differences in other symptoms compared to sacrificing the nerve.</p><p><strong>Level of evidence: </strong>Level I, Therapeutic.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Trauma","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BOT.0000000000003013","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: To discover postoperative symptom differences between nerve-sparing and nerve-sacrificing techniques during ORIF of clavicle fractures.
Patient selection criteria: Patients with closed, isolated, displaced, midshaft clavicle fractures (OTA/AO 15-2A, -2B, -2C) underwent ORIF and were consented and randomized to a "nerve-sacrificing" or "nerve-sparing" group.
Outcome measures and comparisons: Semmes-Weinstein monofilament used to test for sensation changes around the supraclavicular area, single assessment numerical evaluation (SANE) scores and symptom severity level (SSL) providing patient self-reported changes, and patient morbidity questionnaires were issued at follow-up. One trained research fellow measured and mapped area of anesthesia. Outcomes between "nerve-sacrificing" and "nerve-sparing" groups were compared.
Results: 21 patients (median age 41.5, 28.6% female) were randomized to "nerve-sacrificed" and 16 (median age 45.6, 18.8% female) to the "nerve-spared" group. There were no statistical differences in age or gender ratio (p=0.304 and 0.702 respectively). Longitudinal models including an interaction between group and time, showed cohort differences being driven by 12-weeks (49.3 (95% CLM 7.68, 90.92)) and 24-weeks (23.92 (95%CLM 1.70, 46.14)). While point estimates for the spare group were still lower at 2- and 52-weeks, they were not significantly different between groups. SANE scores and SSL data showed improvements in both cohorts over time, however; there were no statistically significant differences between the groups (p=0.176 and 0.155, respectively).
Conclusions: Sparing the supraclavicular nerve during open reduction and internal fixation of clavicle fractures significantly decreased chest-wall area of anesthesia at 12- and 24-weeks postoperatively. However, nerve sparing did not provide clinically significant differences in other symptoms compared to sacrificing the nerve.
期刊介绍:
Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.